Endomyocardial biopsy in a young woman with rapidly progressive heart failure unresponsive to standard therapy shows numerous multinucleated giant cells with extensive necrosis and eosinophils. What is the most appropriate next step?

• A Continue guideline-directed medical therapy alone
• B Permanent pacemaker implantation
• C Intravenous immunoglobulin only
• D High-dose corticosteroids and evaluation for transplantation ✓

Explanation

Giant cell myocarditis carries a fulminant course with median survival around 5 months untreated, and responds partially to immunosuppression with corticosteroids plus agents such as cyclosporine, with early transplant evaluation essential. It must be distinguished from lymphocytic myocarditis by the multinucleated giant cells and extensive necrosis. IVIG lacks proven benefit here, pacemaker addresses conduction disease only, and medical therapy alone is inadequate.

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.