Uncommon History of a Giant Cell Myocarditis

A 48-year-old woman experienced an episode of cardiac decompensation due to a third-degree atrioventricular block. Normal systolic and diastolic functions of both ventricles were documented. A dual-chamber pacemaker was implanted and eliminated the patient’s symptoms. Two years later, the patient was hospitalised due to biventricular heart failure and wide QRS diomyopathy which was documented by echocardiogtachycardias. Pacemaker follow-up revealed a continu- raphy (Figure 1, Figure 2 and Figure 3). Granulomatous giant cell myocarditis ous deterioration of the pacing threshold and of the (GCM) was diagnosed following endomyocardial biopsy evoked action potential combined with a congestive car- (Figure 4 and Figure 5). Since the patient declined evaluation for heart transplantation, immunosuppressive treatment with cyclosporine, azathioprine and prednisolone was established. This resulted in subjective improvement and regression of inflammation and granulomas, but was accompanied by progressive renal failure. Echocardiography showed a remarkable recovery of left and right ventricular function (Figure 6). Thepatient’s condition has remained stable for the past 4 years.