Clinical scenario

This protocol covers acute myocarditis in the specific subtype of lymphocytic myocarditis where no viral aetiology is identified. The virus-negative finding is a clinically important distinction that directly shapes the management approach.

Defining features

The condition is characterised by lymphocytic infiltration on histological assessment in the absence of a detectable virus. This profile points away from an infectious driver and toward an immune-mediated process, which is the basis for targeted intervention.

Treatment approach (partial summary)

The protocol for this scenario involves immunomodulatory therapy. The complete regimen — including specific agents, criteria for their use, and the full clinical algorithm — is available in the structured protocol below.

References

DOI: 10.1093/eurheartj/ehaf192

Lymphocytic myocarditis (virus-negative)
IVIGe or plasmapheresisf
IVIG (immunomodulatory therapy providing pooled IgG antibodies) = standard dose off-label 2 g/kg total dose, typically administered over 1 to 2 days; alternative dosing: 0.4 g/kg/day for 5 consecutive days (less commonly used in myocarditis but sometimes used in autoimmune settings).
Plasmapheresis (therapeutic plasma exchange that filters out and removes circulating autoantibodies, immune complexes, and inflammatory mediators) 3–5 sessions in 5–10 days.

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Treatment of Acute Myocarditis in Virus-Negative Lymphocytic Myocarditis

References