An unusual case of giant cell myocarditis presenting with
cardiogenic shock that dramatically responded to conventional dose of
steroids and azathioprine is reported. Cardiac recovery was rapid,
complete (left ventricular ejection fraction rose to 55% from
10%), and was accompanied by the disappearance of the inflammatory
infiltrates including giant cells in the control endomyocardial biopsy.
Maintenance of the recovery at 16 months of follow-up on a low dose of
azathioprine suggests that giant cell myocarditis might be a
heterogeneous disease having either a negative untreatable trend
necessitating cardiac transplantation, or a curable substrate
responding to immunosuppressive drugs.