Combined Immunosuppression for the Treatment of Idiopathic Giant Cell Myocarditis

Abstract

Based on the published literature, it is not possible to determine whether immunosuppressive treatment that includes muromonab-CD3 is superior to treatment with azathioprine or cyclosporine combined with corticoste-roids. The prognosis of GCM diagnosed by biopsy is poor; however, in rare cases of biopsy-proven GCM, patients may survive more than 1 year after symptom onset.16Ren H Poston Jr, RS Hruban RH Baumgartner WA Baughman KL Hutchins GM Long survival with giant cell myocarditis.Mod Pathol. 1993; 6: 402-407PubMed Google Scholar The standard of care for patients with acute severe heart failure due to GCM should include evaluation for heart transplantation,7Costanzo-Nordin MR Silver MA O'Connell JB Scanlon PJ Robinson JA Giant cell myocarditis: dramalic haemodynamic and histologic improvement with immunosuppressive therapy.Eur Heart J. 1987; 8: 271-274Crossref PubMed Google Scholar39Nieminen MS Salminen US Taskinen E Heikkila P Partanen J Treatment of serious heart failure by transplantation in giant cell myocarditis diagnosed by endomyocafdial biopsy.J Heart Lung Transplant. 1994; 13: 543-545PubMed Google Scholar45Briganti E Esrnore DS Federman J Bergin P Successful heart transplantation in a patient with histopathologically proven giant cell myocarditis [letter].J Heart Lung Transplant. 1993; 12: 880-881PubMed Google Scholar46Cooper DK Schlesinger RG Shrago S Zuhdi N Heart transplantation for giant cell myocarditis [letter].J Heart Lung Transplant. 1994; 13: 555PubMed Google Scholar although some patients die of refractory heart failure and arrhythmia before transplantation can be performed.3Cooper Jr, LT Berry GJ Rizeq M Schroeder JS Giant cell myocarditis.J Heart Lung Transplant. 1995; 14: 394-401PubMed Google Scholar Aggressive immunosuppression, as used in our case, should be reserved for severely ill patients who have not responded to standard therapy and should be provided at institutions that have experience in the use of such agents for the treatment of GCM. A prospective trial of immunosuppressive agents for GCM is needed to determine the optimal therapeutic approach.