Pearls from 12/8/20 Medicine LEADS

Tuesday, December 8, 2020

The Dec. 8, 2020 session of Duke Medicine LEADS featured a case presentation led by Trent Wei, MDLonnie Sullivan, MD; and Stacy Bagrova, MD who presented, "26-year-old male with syncope and fevers."

Experts, Lance Okeke, MD, MPHChet Patel, MD; and John Carney, MD, weighed in for the diagnostic reasoning and discussion.

Here are pearls and takeaways from the session:

  1. Giant Cell Myocarditis (GCM) is the most fatal autoimmune disease, with a median survival of 5.5 months after diagnosis.
  2. GCM is a disease of young and predominantly healthy adults. Mortality is typically due to acute heart failure and ventricular arrhythmias, unless cardiac transplantation is performed.
  3. Pathophysiology of GCM is via T lymphocyte-mediated inflammation of the myocardium. It is often associated with systemic autoimmune diseases (eg. IBD, SLE, RA).
  4. GCM is frequently associated with junctional rhythms and ventricular tachycardia, although bradyarrhythmia and syncope due to new-onset unexplained heart block may also occur both in infectious (eg. Lyme disease) and other immune-mediated forms of myocarditis (eg. Sarcoidosis). 
  5. Immunosuppression with corticosteroids is the backbone of treatment of GCM while awaiting transplantation. There is no clear consensus on immunosuppression regimen due to the rarity of cases. 

Watch the recorded session

Duke Medicine Learning, Education, and Discussion Series (LEADS) takes place each Tuesday at 12 p.m. Learn more and see schedule of upcoming sessions.