Rituximab in recurrent idiopathic giant cell myocarditis after heart transplantation: a potential therapeutic approach

Transpl Int. 2014 May;27(5):e38-42. doi: 10.1111/tri.12270. Epub 2014 Feb 17.


Giant cell myocarditis (GCM) is a very aggressive form of myocardial inflammation. While immunosuppressive therapy is usually able to keep under control the disease and prolong the average transplant-free survival in many patients, effective therapeutic strategies to prevent or treat the recurrence of GCM in transplanted organs are still to be defined. We report the case of a young woman with idiopathic GCM who, despite immediate aggressive immunosuppressive therapy, rapidly progressed to irreversible heart failure and required urgent heart transplantation. Yet, 2 months later, the disease recurred in the transplanted heart, despite an intensive four-drug antirejection regimen. The introduction of rituximab, an anti-CD20 monoclonal antibody, 375 mg/m(2) /week i.v. for four consecutive weeks and then every 4 months as maintenance therapy, determined a complete and steady clinical remission of the disease. After nineteen months since rituximab administration, the patient is doing well and repeated follow-up endo-myocardial biopsies confirmed the complete resolution of myocardial inflammation. Our experience seems to suggest that rituximab can be a reasonably effective and safe therapeutic option in GCM recurring in transplanted organs.

Keywords: giant cell myocarditis; heart transplantation; immunosuppressive therapy; myocarditis; rituximab.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antibodies, Monoclonal, Murine-Derived / therapeutic use*
  • Antigens, CD20 / immunology*
  • Female
  • Giant Cells / pathology*
  • Heart Transplantation / adverse effects*
  • Humans
  • Myocarditis / drug therapy*
  • Recurrence
  • Rituximab


  • Antibodies, Monoclonal, Murine-Derived
  • Antigens, CD20
  • Rituximab