Histologic and Cytokine Response to Immunosuppression in Giant-Cell Myocarditis
Authors: Nat T. Levy
Journal: Annals of Internal Medicine (1998)

Brief Communications15 April 1998Histologic and Cytokine Response to Immunosuppression in Giant-Cell MyocarditisNat T. Levy, MD, Lyle J. Olson, MD, Cornelia Weyand, MD, PhD, Alexander Brack, MD, Henry D. Tazelaar, MD, William D. Edwards, MD, and Stephen C. Hammill, MDNat T. Levy, MDFrom the Mayo Clinic, Rochester, Minnesota.Search for more papers by this author, Lyle J. Olson, MDFrom the Mayo Clinic, Rochester, Minnesota.Search for more papers by this author, Cornelia Weyand, MD, PhDFrom the Mayo Clinic, Rochester, Minnesota.Search for more papers by this author, Alexander Brack, MDFrom the Mayo Clinic, Rochester, Minnesota.Search for more papers by this author, Henry D. Tazelaar, MDFrom the Mayo Clinic, Rochester, Minnesota.Search for more papers by this author, William D. Edwards, MDFrom the Mayo Clinic, Rochester, Minnesota.Search for more papers by this author, and Stephen C. Hammill, MDFrom the Mayo Clinic, Rochester, Minnesota.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-128-8-199804150-00007 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Giant-cell myocarditis is characterized by heart block, ventricular arrhythmia, congestive heart failure, and a high mortality rate [1-3]. A previous study [4] suggested that myocardial inflammation is mediated by T cells and giant cells. We report on two patients with giant-cell myocarditis, one of whom responded favorably to cytolytic therapy with muromonab-CD3. Cytokine analysis, immunophenotyping, and T-cell receptor α-chain quantitation were performed to characterize the immunologic features of giant-cell myocarditis.Case ReportsPatient 1A 34-year-old woman was hospitalized for angina. Electrocardiography showed acute injury, and treatment included aspirin, heparin, and tissue plasminogen activator. Coronary arteriography showed no coronary artery disease. ...References1. Tesluk H. Giant cell versus granulomatous myocarditis. Am J Clin Pathol. 1956; 26:1326-33. Google Scholar2. Ren H, Poston RS Jr, Hruban RH, Baumgartner WA, Baughman KL, Hutchins GM. Long survival with giant cell myocarditis. Mod Pathol. 1993; 6:402-7. Google Scholar3. Cooper LT, Berry GJ, Rizeq M, Schroeder JS. Giant cell myocarditis. J Heart Lung Transplant. 1995; 14:394-401. Google Scholar4. Litovsky SH, Burke AP, Virmani R. Giant cell myocarditis: an entity distinct from sarcoidosis characterized by multiphasic myocyte destruction by cytotoxic T cells and histiocytic giant cells. Mod Pathol. 1996; 9:1126-34. Google Scholar5. Weyand CM, Tetzlaff N, Bjornsson J, Brack A, Younge B, Goronzy JJ. Disease patterns and tissue cytokine profiles in giant cell arteritis. Arthritis Rheum. 1997; 40:19-26. Google Scholar6. Theaker JM, Gatter KD, Brown DC, Heryet A, Davies MJ. An investigation into the nature of giant cells in cardiac and skeletal muscle. Hum Pathol. 1988; 19:974-9. Google Scholar7. Saeki M, Takahashi-Iwanaga H, Iwanaga T, Fujita T, Kodama M, Hanawa H, et al. Morphological analysis of multinucleated giant cells occurred in experimental autoimmune myocarditis. Tohoku J Exp Med. 1994; 172:195-204. Google Scholar8. Zhang S, Kodama M, Hanawa H, Izumi T, Shibata A, Masani F. Effects of cyclosporine, prednisolone and aspirin on rat autoimmune giant cell myocarditis. J Am Coll Cardiol 1993; 21:1254-60. Google Scholar9. Hanawa H, Kodama M, Inomata T, Izumi T, Shibata A, Tuchida M, et al. Anti-α β T cell receptor antibody prevents the progression of experimental autoimmune myocarditis. Clin Exp Immunol. 1994; 96:470-5. Google Scholar10. Cooper LT Jr, Berry GJ, Shabetai R. Idiopathic giant cell myocarditis-natural history and treatment. N Engl J Med. 1997; 336:1860-6. Google Scholar11. Mason JW, O'Connell JB, Herskowitz A, Rose NR, McManus BM, Billingham ME, et al. A clinical trial of immunosuppressive therapy for myocarditis. N Engl J Med. 1995; 333:269-75. Google Scholar Author, Article, and Disclosure InformationAffiliations: From the Mayo Clinic, Rochester, Minnesota.Corresponding Author: Lyle J. Olson, MD, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.Current Author Addresses: Dr. Levy: 8360 Delmare #2N, St. Louis, MO 63124. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByA case of a giant cell myocarditis that developed massive left ventricular thrombus during percutaneous cardiopulmonary supportSmall Steps for Idiopathic Giant Cell MyocarditisIdiopathic giant cell myocarditis and cardiac sarcoidosisResolution of Giant Cell Myocarditis After Extended Ventricular AssistanceDiagnosis and management of viral myocarditisGiant Cell and Granulomatous MyocarditisRecent Advances in Giant Cell MyocarditisInnovative Drug Treatments for Viral and Autoimmune MyocarditisMyocarditisSurvival Outcomes of Patients with Giant Cell Myocarditis Bridged by Ventricular Assist DevicesGiant cell myocarditis: Most fatal of autoimmune diseasesCombined Immunosuppression for the Treatment of Idiopathic Giant Cell Myocarditis 15 April 1998Volume 128, Issue 8Page: 648-650KeywordsBiopsyCellsCytokinesGiant cellsLymphocytesMyocarditisNatural killer cellsT cell receptorsT cellsTransplantation Issue Published: 15 April 1998 CopyrightCopyright © 1998 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...