Recovery from Giant Cell Myocarditis with ECMO Support and Utilisation of Polyclonal Antithymocyte Globulin: A Case Report

Abstract

Giant cell myocarditis (GCM) is a rare and frequently fatal disorder. Patients suffer of ventricular arrhythmias or congestive heart failure. Here we describe a patient with cardiogenic shock and histological verified GCM. The patient was saved by implantation of extracorporeal membrane oxygeneation (ECMO) device and concomitant application of Rabbit antithymocyte globuline (rATG, Thymoglobulin, Sangstat), cyclosporine, and steroids in the acute event. 12 months after the crisis the patient evidences NYHA class I heart function and only a moderate impairment of heart function (EF 55 %). The novel utilisation of ECMO in GCM related cardiogenic shock and application of rATG have prooven life-saving in this patient. Studies utilizing rATG in the treatment of GCM are warrented.

Key words

Giant cell myocarditis - autoimmunity - rATG - ECMO - myocarditis - VAD - surgery

References

• 1 Cooper L T, Berry G J, Shabetai R. Idiopathic giant cell myocarditis - natural history and treatment.  N Engl J Med. 1997;  336 1860-1866
• 2 Taghavi S, Ankersmit H J, Wieselthaler G, Gorlitzer M, Rajek A, Wolner E, Grimm M. Extracorporeal membrane oxygenation for graft failure after heart transplantation: recent Vienna experience.  J Thorac Cardiovasc Surg. 2001;  122 819-820
• 3 Deo Y M, Granziano R F, Repp R, van der Winkel J G. Clinical significance of IgG Fc receptors and FcGR-directed immunotherapies.  Immunol Today. 1997;  18 127-135
• 4 Shioji K, Kishimotot C, Sasayama S. Fc receptor-mediated inhibitory effect of immunoglobulin therapy on autoimmune giant cell myocarditis: concomitant suppression of the expression of dendritic cells.  Circ Res. 2001;  89 540-546
• 5 George J, Barshack I, Malka E. et al . The effect of intravenous immunoglobulins on the progression of experimental autoimmune myocarditis in the rat.  Exp Mol Pathology. 2001;  71 55-62
• 6 McNamara D M, Holubkov R, Starling R C. et al . Controlled trial of intravenous immune globulin in recent-onset dilated cardiomyopathy.  Circulation. 2001;  103 2254-2259
• 7 Hoetzenecker K, Hacker S, Hoetzenecker W. et al . Pooled human IgG and IgM has immunesuppressive properties in vitro and is partly triggered by Fc blockade.  E Surgery, Acta Chirurgica Austriaca. 2005;  37 (Suppl. 205) 26