Giant Cell Myocarditis.

Korean J Leg Med. 2001 Oct;25(2):38-42. Korean.

Department of Forensic Medicine, National Institute of Scientific Investigation.

Giant cell myocarditis is a rare rapidly fatal disease of unknown cause, often occuring in young to middle-aged adults. Most presented with congestive heart failure, ventricular arrhythmia, heart block or sudden cardiac death. The histologic hallmarks of giant cell myocarditis include a polymorphous inflammatory response with numerous multinucleated giant cells and myocyte necrosis. Response to immunosuppresive therapy is poor and cardiac transplantation is considered to be the treatment of choice. We experienced 4 cases of giant cell myocarditis, all of which were autopsied and underwent postmortem pathologic examination. Grossly, the heart was enlarged, measuring up to 510 gm, with thickend septal and ventricular wall. Microscopically, 3 cases showed diffuse active myocarditis with extensive myocyte necrosis, while 1 case showed exuberant fibrosis. Many multinucleated giant cells were present throughout the lesion. Immunohistochemical stain supports the view that the giant cells have a histiocytic origin. Neither microorganisms nor foreign material were found on PAS and AFB stains. Because giant cell myocarditis is on occasion associated wth immunologic disorders, autopsy should be carefully performed to define the correlation between the two.

Key Words : Giant cell myocarditis, Sudden death