Importance of endomyocardial biopsy in distinguishing between cardiac sarcoidosis and giant cell myocarditis

2018 ◽  
Vol 131 (7-8) ◽  
pp. 186-187
Author(s):  
Petr Kuchynka ◽  
Tomas Palecek ◽  
Lukas Lambert ◽  
Antonin Fikrle ◽  
Ivana Vitkova ◽  
...  
Keyword(s):  
Giant Cell ◽  
Endomyocardial Biopsy ◽  
Cardiac Sarcoidosis ◽  
Giant Cell Myocarditis

scholarly journals Fulminant cardiac sarcoidosis resembling giant cell myocarditis: a case report

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Ginger Y Jiang ◽  
Qizhe Cai ◽  
E Wilson Grandin ◽  
Marwa A Sabe
Keyword(s):  
Giant Cell ◽  
Endomyocardial Biopsy ◽  
Cardiac Sarcoidosis ◽  
Obstructive Coronary Artery Disease ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
High Dose ◽  
Rare Presentation ◽  
Ventricular Ejection Fraction ◽  
Giant Cell Myocarditis

Abstract Background Severe cardiac sarcoidosis (CS) can share clinical and histopathologic features with giant cell myocarditis (GCM). Case summary A 56-year-old female presented with 1 week of exertional chest pressure and dyspnoea. Echocardiogram demonstrated extensive regional dysfunction with left ventricular ejection fraction (LVEF) 38%. Cardiac catheterization revealed no obstructive coronary artery disease and cardiac index 1.5 L/min/m2. Cardiac magnetic resonance imaging (MRI) demonstrated diffuse late gadolinium enhancement. Positron emission tomography with fluorodeoxyglucose (FDG) (FDG-PET) computed tomography showed FDG uptake in the anteroseptal and anterior wall and no extracardiac activity. Endomyocardial biopsy (EMB) demonstrated fragments of endocardial fibrosis with mixed inflammatory infiltrate including histiocytic giant cells, which could be due to CS or GCM. She was initially treated for GCM with high dose steroids, tacrolimus, and mycophenolate mofetil. Repeat EMB was pursued and demonstrated multiple granulomas with sharp demarcation from adjacent uninvolved myocardium consistent with CS. A dual-chamber implantable cardioverter-defibrillator was placed, and immunosuppression was changed to prednisone alone with plan for infliximab. Discussion This case illustrates a rare presentation of fulminant isolated CS. Endomyocardial biopsy with sufficient tissue was critical to establish a diagnosis and initiate appropriate immunosuppression.

scholarly journals 5697Heart transplantation in giant cell myocarditis and cardiac sarcoidosis

2017 ◽  
Vol 38 (suppl_1) ◽  
Author(s):  
D. Velikanova ◽  
J. Lehtonen ◽  
P. Simonen ◽  
M. Kupari
Keyword(s):  
Giant Cell ◽  
Cardiac Sarcoidosis ◽  
Giant Cell Myocarditis

scholarly journals P2576Comparison of giant cell myocarditis and cardiac sarcoidosis in a nationwide registry

2017 ◽  
Vol 38 (suppl_1) ◽  
Author(s):  
H.-K. Nordenswan ◽  
K. Ekstrom ◽  
J. Lehtonen ◽  
M. Kupari ◽  
Keyword(s):  
Giant Cell ◽  
Cardiac Sarcoidosis ◽  
Giant Cell Myocarditis ◽  
Nationwide Registry

Rejection in heart transplantation for cardiac sarcoidosis mimicking idiopathic giant cell myocarditis

2019 ◽  
Vol 20 (4) ◽  
pp. 264-266 ◽  
Author(s):  
Concetta Di Nora ◽  
Daniela Miani ◽  
Sandro Sponga ◽  
Ugolino Livi
Keyword(s):  
Heart Transplantation ◽  
Giant Cell ◽  
Cardiac Sarcoidosis ◽  
Giant Cell Myocarditis

scholarly journals Idiopathic giant cell myocarditis or cardiac sarcoidosis? A retrospective audit of a nationwide case series

2020 ◽  
Vol 7 (3) ◽  
pp. 1362-1370 ◽  
Author(s):  
Kaj Ekström ◽  
Anne Räisänen‐Sokolowski ◽  
Jukka Lehtonen ◽  
Hanna‐Kaisa Nordenswan ◽  
Mikko I. Mäyränpää ◽  
...  
Keyword(s):  
Giant Cell ◽  
Cardiac Sarcoidosis ◽  
Case Series ◽  
Giant Cell Myocarditis ◽  
Retrospective Audit

Idiopathic giant cell myocarditis and cardiac sarcoidosis

2012 ◽  
Vol 18 (6) ◽  
pp. 733-746 ◽  
Author(s):  
Lori A. Blauwet ◽  
Leslie T. Cooper
Keyword(s):  
Giant Cell ◽  
Cardiac Sarcoidosis ◽  
Giant Cell Myocarditis

scholarly journals Cardiac Sarcoidosis or Giant Cell Myocarditis? On Treatment Improvement of Fulminant Myocarditis as Demonstrated by Cardiovascular Magnetic Resonance Imaging

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Hari Bogabathina ◽  
Peter Olson ◽  
Vikas K. Rathi ◽  
Robert W. W. Biederman
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Giant Cell ◽  
Cardiac Sarcoidosis ◽  
Severe Heart Failure ◽  
Fulminant Myocarditis ◽  
Resonance Imaging ◽  
Giant Cell Myocarditis ◽  
Pathological Differentiation ◽  
Treatment Improvement

Giant cell myocarditis, but not cardiac sarcoidosis, is known to cause fulminant myocarditis resulting in severe heart failure. However, giant cell myocarditis and cardiac sarcoidosis are pathologically similar, and attempts at pathological differentiation between the two remain difficult. We are presenting a case of fulminant myocarditis that has pathological features suggestive of cardiac sarcoidosis, but clinically mimicking giant cell myocarditis. This patient was treated with cyclosporine and prednisone and recovered well. This case we believe challenges our current understanding of these intertwined conditions. By obtaining a sense of severity of cardiac involvement via delayed hyperenhancement of cardiac magnetic resonance imaging, we were more inclined to treat this patient as giant cell myocarditis with cyclosporine. This resulted in excellent improvement of patient’s cardiac function as shown by delayed hyperenhancement images, early perfusion images, and SSFP videos.

scholarly journals Myocarditis and Inflammatory Cardiomyopathy

2021 ◽  
Author(s):  
Emanuele Bobbio ◽  
Kristjan Karason
Keyword(s):  
Heart Failure ◽  
Giant Cell ◽  
Cardiac Sarcoidosis ◽  
Circulatory Support ◽  
Inflammatory Cardiomyopathy ◽  
Giant Cell Myocarditis ◽  
Lymphocytic Myocarditis ◽  
Randomized Intervention ◽  
Eosinophilic Myocarditis ◽  
Intervention Trials

Activation of the inflammatory system occurs in most patients with advanced heart failure, regardless of etiology, and contributes to the pathophysiological milieu and the progression of the disease. The term inflammatory cardiomyopathy (ICM) refers to a group of disorders for which an acute or chronic myocardial inflammation is the central cause of abnormal cardiac structure or impaired cardiac function. The most common cause of inflammatory cardiomyopathy is lymphocytic myocarditis, which is most usually triggered by a viral infection, and occasionally by other infectious agents. Rare causes of specific inflammatory cardiomyopathies include cardiac sarcoidosis, giant cell myocarditis and eosinophilic myocarditis. Inflammatory cardiomyopathy can also occur in connection with autoimmune inflammatory diseases. Typical manifestations of inflammatory cardiomyopathy include chest pain, heart failure, and arrhythmias, but these symptoms and signs are unspecific. Although non-invasive diagnostic methods are emerging, the gold standard of diagnosis is the histological examination of an endomyocardial biopsy. Owing to the invasive nature of this technique and a modest diagnostic sensitivity, its use is limited. Therefore, the identification of inflammatory cardiomyopathy is elusive and the true incidence of the condition remains unknown. In most cases of lymphocytic myocarditis, recovery occurs within a few weeks following supportive treatment. In patients with cardiac sarcoidosis, giant cell myocarditis or eosinophilic myocarditis the use of immunosuppressive treatment is recommended, as is the case in myocarditis associated with autoimmune disorders. Such interventions may also have beneficial effects in chronic viral myocarditis once the virus has been cleared. In severe cases, treatment with mechanical circulatory support and/or heart transplantation may be required. Randomized intervention trials including antiviral, immunomodulating, or immunosuppressive agents are lacking. Similarly, new molecular-based methods and therapies tailored to specific pathogeneses have a potential to improve diagnosis and outcomes in patients with inflammatory cardiomyopathy. Still, such techniques and interventions are to be evaluated in adequate randomized controlled studies.

scholarly journals Improved diagnosis of idiopathic giant cell myocarditis and cardiac sarcoidosis by myocardial gene expression profiling

2014 ◽  
Vol 35 (32) ◽  
pp. 2186-2195 ◽  
Author(s):  
D. Lassner ◽  
U. Kuhl ◽  
C. S. Siegismund ◽  
M. Rohde ◽  
S. Elezkurtaj ◽  
...  
Keyword(s):  
Gene Expression ◽  
Gene Expression Profiling ◽  
Giant Cell ◽  
Expression Profiling ◽  
Cardiac Sarcoidosis ◽  
Giant Cell Myocarditis ◽  
Myocardial Gene Expression
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