Treatment and outcome of biopsy-proven fulminant myocarditis in adults.

Fulminant myocarditis may be rapidly fatal with severe haemodynamic compromise in previously healthy patients. We reviewed our experience with eight cases of biopsy-proven fulminant myocarditis (seven cases with lymphocytic myocarditis and one with eosinophilic myocarditis). Immunosuppression was given in seven out of eight cases. Mechanical circulatory support was required in 50% of the patients. Time from onset of illness to recovery of ventricular function varied from 12 to 17 days. All except one patient were alive at a mean follow-up of 4.4 years after the acute illness. Patients with acute fulminant myocarditis should be treated aggressively with immunosuppression and, if necessary, mechanical circulatory support during the first 2 to 3 weeks of the illness because of the reversible nature of this illness and good long-term prognosis.