A 24-year-old man develops rapidly progressive heart failure with recurrent sustained ventricular tachycardia within three weeks of a flu-like illness. He does not respond to standard heart failure therapy. Endomyocardial biopsy shows extensive necrosis with multinucleated giant cells without granulomas or caseation. What is the most appropriate next step in management?

• A Combination immunosuppression with corticosteroids plus calcineurin inhibitor, with transplant evaluation ✓
• B Supportive therapy alone, since recovery is expected within weeks
• C High-dose antiviral therapy with oseltamivir
• D Antituberculous quadruple therapy empirically

Explanation

Giant cell myocarditis is a rare, fulminant disorder of young adults marked by intractable ventricular arrhythmias and rapidly declining EF, with a median survival of only months if untreated. Biopsy reveals multinucleated giant cells with diffuse myocyte necrosis and no granulomas, distinguishing it from sarcoidosis and tuberculosis. Immunosuppressive regimens combining steroids with agents such as cyclosporine improve outcomes, but many patients progress to mechanical support or transplantation, so early listing is essential.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.