{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T03:39:49Z","timestamp":1775187589384,"version":"3.50.1"},"reference-count":11,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2022,2,3]],"date-time":"2022-02-03T00:00:00Z","timestamp":1643846400000},"content-version":"vor","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Japan Heart Foundation Research","award":["JP19K09256"],"award-info":[{"award-number":["JP19K09256"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,2,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>A recently indicated immunotherapy strategy, combined with mechanical circulatory support (MCS), seems to improve outcomes in patients with fulminant giant cell myocarditis (GCM). However, characterizing a definitive clinical outcome of this strategy remains challenging, and the autoimmunity associated with the onset of GCM remains controversial.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>A 26-year-old man with poor control of atopic dermatitis and ulcerative colitis presented with cardiogenic shock requiring MCS. He was diagnosed with fulminant GCM; hence, immunotherapy (including steroids and intravenous immunoglobulin) was administered and an extracorporeal left ventricular assist device (LVAD) was needed. As the patient complained of prominent fatigue and double vision before myocarditis onset, and acetylcholine receptor-binding antibody titres were elevated, he was diagnosed with myasthenia gravis (MG). No anti-striational antibodies known to be associated with GCM in patients with MG were found in the patient\u2019s serum. Cyclosporin-based immunosuppression under LVAD therapy led to an almost complete resolution of his muscle weakness, intermittent ptosis, and cardiac dysfunction along with the histopathological remission of GCM resulting in LVAD removal. He remained at home without recurrence of GCM and worsening symptoms of MG over the 6-month period following discharge.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>We describe a case of GCM with multiple autoimmune disorders, which recovered by treatment with early cyclosporin-based immunosuppressive therapy under LVAD therapy. The present case suggests the involvement of unknown anti-striational antibodies in the development of GCM in patients with MG and may provide information to guide a novel therapeutic regimen for patients with fulminant GCM requiring mechanical circulatory support.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytac046","type":"journal-article","created":{"date-parts":[[2022,2,8]],"date-time":"2022-02-08T21:35:47Z","timestamp":1644356147000},"source":"Crossref","is-referenced-by-count":5,"title":["Successful bridge to recovery in a patient with fulminant giant cell myocarditis that developed from multiple autoimmune disorders including myasthenia gravis: a case report"],"prefix":"10.1093","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2632-5199","authenticated-orcid":false,"given":"Nobuichiro","family":"Yagi","sequence":"first","affiliation":[{"name":"Department of Transplant Medicine, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shinmachi, Suita, Osaka 564-0018, Japan"},{"name":"Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465, Kajicho, Kamigyoku, Kyoto 602-8566, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takuya","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Transplant Medicine, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shinmachi, Suita, Osaka 564-0018, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshihiko","family":"Ikeda","sequence":"additional","affiliation":[{"name":"Department of Pathology, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shinmachi, Suita, Osaka 564-0018, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1367-4066","authenticated-orcid":false,"given":"Norihide","family":"Fukushima","sequence":"additional","affiliation":[{"name":"Department of Transplant Medicine, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shinmachi, Suita, Osaka 564-0018, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2022,2,3]]},"reference":[{"key":"2022022109082684900_ytac046-B1","doi-asserted-by":"crossref","first-page":"1860","DOI":"10.1056\/NEJM199706263362603","article-title":"Idiopathic giant cell myocarditis\u2014natural history and treatment","volume":"336","author":"Cooper","year":"1997","journal-title":"N Engl J Med"},{"key":"2022022109082684900_ytac046-B2","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.1001\/archneurol.2009.229","article-title":"Autoimmune targets of heart and skeletal muscles in myasthenia gravis","volume":"66","author":"Suzuki","year":"2009","journal-title":"Arch Neurol"},{"key":"2022022109082684900_ytac046-B3","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1253\/circj.CJ-19-0847","article-title":"Mechanical circulatory support combined with immunosuppression for the treatment of giant cell myocarditis\u2014a single-center experience in Japan","volume":"84","author":"Nakajima-Doi","year":"2020","journal-title":"Circ J"},{"key":"2022022109082684900_ytac046-B4","doi-asserted-by":"crossref","first-page":"3905","DOI":"10.3390\/jcm9123905","article-title":"Outcomes of mechanical circulatory support for giant cell myocarditis: a systematic review","volume":"9","author":"Patel","year":"2020","journal-title":"JCM"},{"key":"2022022109082684900_ytac046-B5","doi-asserted-by":"crossref","first-page":"1452","DOI":"10.1002\/ejhf.606","article-title":"Long-term outcome and its predictors in giant cell myocarditis","volume":"18","author":"Ekstrom","year":"2016","journal-title":"Eur J Heart Fail"},{"key":"2022022109082684900_ytac046-B6","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1161\/CIRCHEARTFAILURE.112.969261","article-title":"Diagnosis, treatment, and outcome of giant-cell myocarditis in the era of combined immunosuppression","volume":"6","author":"Kandolin","year":"2013","journal-title":"Circ Heart Fail"},{"key":"2022022109082684900_ytac046-B7","doi-asserted-by":"crossref","first-page":"185896","DOI":"10.4061\/2010\/185896","article-title":"Fulminant giant cell myocarditis and cardiogenic shock: an unusual presentation of malignant thymoma","volume":"2010","author":"Koul","year":"2010","journal-title":"Cardiol Res Pract"},{"key":"2022022109082684900_ytac046-B8","doi-asserted-by":"crossref","first-page":"1733","DOI":"10.1016\/j.amjcard.2015.03.023","article-title":"Long-term risk of recurrence, morbidity and mortality in giant cell myocarditis","volume":"115","author":"Maleszewski","year":"2015","journal-title":"Am J Cardiol"},{"key":"2022022109082684900_ytac046-B9","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1016\/j.nmd.2014.06.434","article-title":"Two patients with co-morbid myasthenia gravis in a Brazilian cohort of inflammatory bowel disease","volume":"24","author":"Gondim","year":"2014","journal-title":"Neuromuscul Disord"},{"key":"2022022109082684900_ytac046-B10","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1056\/NEJMoa1602489","article-title":"Randomized trial of thymectomy in myasthenia gravis","volume":"375","author":"Wolfe","year":"2016","journal-title":"N Engl J Med"},{"key":"2022022109082684900_ytac046-B11","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1016\/j.jtcvs.2005.09.035","article-title":"Fatal giant cell myocarditis after thymoma resection in myasthenia gravis","volume":"131","author":"Joudinaud","year":"2006","journal-title":"J Thorac Cardiovasc Surg"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcr\/advance-article-pdf\/doi\/10.1093\/ehjcr\/ytac046\/42376305\/ytac046.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/6\/2\/ytac046\/42565713\/ytac046.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/6\/2\/ytac046\/42565713\/ytac046.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,21]],"date-time":"2022-02-21T11:41:12Z","timestamp":1645443672000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytac046\/6521026"}},"subtitle":[],"editor":[{"given":"Luca","family":"Arcari","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"A Shaheer","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Alessia","family":"Gambaro","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Linh","family":"Ngo","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Fabienne","family":"Vervaat","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2022,2,1]]},"references-count":11,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2022,2,3]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytac046","relation":{},"ISSN":["2514-2119"],"issn-type":[{"value":"2514-2119","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,2,1]]},"published":{"date-parts":[[2022,2,1]]},"article-number":"ytac046"}}