Nat T. Levy, MD; Lyle J. Olson, MD; Cornelia Weyand, MD, PhD; Alexander Brack, MD; Henry D. Tazelaar, MD; William D. Edwards, MD; Stephen C. Hammill, MD
Levy N., Olson L., Weyand C., Brack A., Tazelaar H., Edwards W., Hammill S.; Histologic and Cytokine Response to Immunosuppression in Giant-Cell Myocarditis. Ann Intern Med. 1998;128:648-650. doi: 10.7326/0003-4819-128-8-199804150-00007
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Published: Ann Intern Med. 1998;128(8):648-650.
Giant-cell myocarditis is characterized by heart block, ventricular arrhythmia, congestive heart failure, and a high mortality rate [1-3]. A previous study  suggested that myocardial inflammation is mediated by T cells and giant cells. We report on two patients with giant-cell myocarditis, one of whom responded favorably to cytolytic therapy with muromonab-CD3. Cytokine analysis, immunophenotyping, and T-cell receptor α-chain quantitation were performed to characterize the immunologic features of giant-cell myocarditis.
A 34-year-old woman was hospitalized for angina. Electrocardiography showed acute injury, and treatment included aspirin, heparin, and tissue plasminogen activator. Coronary arteriography showed no coronary artery disease. Ventricular tachycardia developed, and left ventricular ejection fraction declined to 19%. Endomyocardial biopsy showed giant-cell myocarditis. Immunosuppression with methylprednisolone (10 mg/kg of body weight every 24 hours for 3 days) was initiated, and a 7-day course of muromonab-CD3 was administered. Cyclosporine, prednisone, and azathioprine were given to maintain immunosuppression.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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