A 47-year-old woman presents to the hospital with a 3 month history of shortness of breath. Prior echocardiogram was unremarkable. Cardiac MRI one month prior showed late gadolinium enhancement and a troponin was 0.3. A Cardiac PET/CT at last admission showed patchy diffuse hypermetabolism. A biopsy was performed.
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This is an unusual case in that it has features of both giant cell myocarditis and sarcoidosis. The infiltrative pattern, with adjacent myocyte injury along with numerous eosinophils favors giant cell myocarditis. The large "fluffy" giant cells with inclusions reminiscent of asteroid bodies, are more typical of sarcoidosis. It may be there is an intermediate group of less aggressive giant cell myocarditis cases or more agressive sarcoid cases that have this histopathology. Indeed, this case was not hyperagressive as typical of other giant cell myocarditis cases. Drs. Maleszewski and Halushka are interested in studying this intermediate entitity. If you have a case and would be interested in sharing it, for such a study, please contact Marc Halushka.
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