Clinical Case of Idiopathic Abramov-Fiedler Myocarditis in The Elderly

Abramov-Fiedler myocarditis (idiopathic giant cell myocarditis) represents one of the most malignant forms of non-rheumatic inflammatory heart disease. It is typically diagnosed in young and middle-aged patients and is characterized by rapidly progressive heart failure, life-threatening arrhythmias, and thromboembolic complications. The present clinical observation is of particular interest due to the development of Abramov-Fiedler myocarditis in an elderly patient, which is uncommon for this condition. An 80-year-old male was admitted with a clinical picture of ST-segment elevation acute coronary syndrome. On admission, he presented with severe retrosternal chest pain, hypotension, dyspnea, and signs of acute left ventricular failure. Laboratory tests revealed markedly elevated troponin and cytolytic enzymes. Electrocardiography demonstrated ST-segment elevation in the inferolateral wall of the left ventricle, while coronary angiography showed only a 30 % stenosis of the right coronary artery with preserved coronary flow. Despite intensive therapy, the patient developed cardiogenic shock and died on the second day of illness. Post-mortem examination revealed extensive myocardial inflammatory lesions with dystrophic and necrotic changes of cardiomyocytes, massive mixed-cell infiltration, and the presence of multinucleated giant cells. Immunohistochemical staining using CD68 antibodies confirmed the macrophage origin of the infiltrating elements, consistent with the diagnosis of giant cell myocarditis. This clinical case highlights the diagnostic challenges of atypical Abramov–Fiedler myocarditis in elderly patients, where the presentation may closely mimic acute coronary syndrome. The findings emphasize the importance of maintaining clinical vigilance for inflammatory myocardial diseases in older individuals and underscore the decisive role of morphological and immunohistochemical confirmation in establishing the diagnosis.