key: cord-0959314-omilwair
authors: Fine, Nowell M.
title: Giant Cell Myocarditis: Still the Deadly Giant
date: 2020-08-19
journal: JACC Case Rep
DOI: 10.1016/j.jaccas.2020.07.001
sha: 3806fd231d0bb3561ee85226b6fb7e40fa6cb0b5
doc_id: 959314
cord_uid: omilwair

[Figure: see text]

overall poor prognosis. GCM presents significant challenges at all stages of its disease course, from its initial presentation through to its long-term management for those patients who survive the acute stage.

As a result, there has been much written about GCM; however, our knowledge about the disease has actually advanced relatively slowly, and much remains uncertain and still to be determined. As an example, the pathophysiology of GCM is not well understood beyond its recognition as an autoimmune disorder attributable to T-lymphocyte-mediated myocardial inflammation (1). There is a known association with other autoimmune disorders such as inflammatory bowel disease, fibromyalgia, and Hashimoto thyroiditis (2) . However, the true nature of this relationship, including which patients may be most at risk for GCM, remains unclear. Furthermore, in some series, more indolent presentations of GCM have been described (1, 4, 5) .

Therefore, diagnostic confirmation requires demon- However, pathologic characteristics may resemble those of other forms of myocarditis, in particular cardiac sarcoidosis, whose primary distinguishing feature is the predominance of noncaseating granulomas, as well as more extensive fibrosis (6). In addition, EMB may also be subject to sampling error, leading to a possible false negative result, and therefore the need for repeat EMB in the setting of high clinical suspicion in a patient with a negative or equivocal pathologic result has been advocated (1, 4, 7) . Some reports have also recommended targeted biopsy of involved myocardial regions on the basis of cardiovascular magnetic resonance findings 

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