Obrovskobuněčná myokarditida u mladé ženy odhalená při pitvě: kazuistika

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Authors: Jan Hrudka ¹; Ondřej Fabián ^2,3; Róbert Petr ⁴; Tomáš Balík ⁵
Authors‘ workplace: Department of Pathology, 3rd Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czech Republic. ¹; Clinical and Transplant Pathology Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. ²; Department of Pathology and Molecular Medicine, 3rd Faculty of Medicine, Charles University, Thomayer Hospital, Prague, Czech Republic. ³; Department of Cardiology, 3rd Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czech Republic. ⁴; Department of Anaesthesia and Intensive Care Medicine, 3rd Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czech Republic. ⁵
Published in: Čes.-slov. Patol., 57, 2021, No. 3, p. 174-178
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Overview

Obrovskobuněčná myokarditida (OBM) je vzácné zánětlivé onemocnění srdce postihující často mladé osoby. Klinický průběh je typicky prudký, s fulminantním městnavým srdečním selháním. Prognóza je špatná, správná diagnóza je často stanovena až při pitvě.

V této práci popisujeme případ této vzácné myokarditidy postihující 44letou, do té doby zdravou ženu, která byla hospitalizována na klinice anesteziologie a resuscitace po náhlé srdeční zástavě a mimonemocniční resuscitaci. Echokardiografie a zobrazovací vyšetření prokázala těžkou dysfunkci a dilataci obou komor, bez významného nálezu na koronárních tepnách. Dvanáct dní po přijetí pacientka zemřela pod obrazem městnavého srdečního selhání refrakterního na terapii. Při histologickém vyšetření srdce po pitvě byla v myokardu obou komor nalezena mnohočetná nekrotická ložiska s hustou zánětlivou celulizací s účastí hojných obrovských vícejaderných histiocytů, v souladu s diagnózou OBM.

Článek diskutuje patologickou anatomii, patofyziologii a histologickou diferenciální diagnostiku této vzácné choroby, součásti je i přehled recentní literatury popisující neobvyklé a nové jednotky.

Klíčová slova:

obrovskobuněčná myokarditida – městnavé srdeční selhání – pitva

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