The multiple faces of autoimmune/immune-mediated myocarditis in children: a biopsy-proven case series treated with immunosuppressive therapy

The role of immunosuppressive therapy (IT) in paediatric autoimmune/immune-mediated myocarditis remains poorly defined. To explore its role, we present a series of three consecutive paediatric patients with biopsy-proven, virus negative, autoimmune/immune-mediated myocarditis, with distinct clinical and pathological features, who have been successfully treated with IT, a 14-year-old boy with Loeffler's fibroblastic parietal endomyocarditis, a 6-year-old child with celiac disease with chronic active lymphocytic myocarditis, and a 13-year-old boy with long-standing heart failure and active lymphocytic myocarditis. Patients started IT and entered follow-up between July 2017 and September 2019; the first patient completed IT. IT was associated with a substantial and sustained recovery of cardiac function in our patients, regardless of their heterogeneous clinical and pathological features. Combination IT was well tolerated and enabled tapering and weaning off steroids.

Automated summary

This study reported three cases of pediatric autoimmune/immune-mediated myocarditis successfully treated with immunosuppressive therapy (IT). IT was associated with a substantial and sustained recovery of cardiac function in the patients, regardless of their heterogeneous clinical and pathological features. Combination IT was well tolerated and enabled tapering and weaning off steroids.