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Several viruses can cause myocarditis and are mentioned in Section 3.4. The specific therapies for viral aetiologies can be found in Section 9.5 for influenza-, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-, and HIV-associated myocarditis. For specific aetiologies, refer to the subsections on LM (Section 9.1), EM (Section 9.2), GCM (Section 9.3), CS (Section 9.4), LC (Section 9.5.2), CD (Section 9.5.3), and ICI-associated myocarditis (Section 9.6.1.1).

Specific medical therapies are summarized in Table 12.

Table 12 Therapy for specific forms of myocarditis

Lymphocytic myocarditis (virus-negative)

1st line therapy Non-severe: prednisone 1 mg/kg/day p.o. then tapered

Severe: i.v. methylprednisolone 7–14 mg/kg/day for 3 days, then 1 mg/kg/day p.o.

2nd line therapy Oral corticosteroids + azathioprinea or mycophenolate mofetilb, cyclosporinec, methotrexated 3rd line therapy IVIGe or plasmapheresisf Eosinophilic myocarditis 1st line therapy Same as lymphocytic myocarditis + Treat EM-associated condition if identified 2nd line therapy Same as lymphocytic myocarditis + Treat EM-associated condition if identified 3rd line therapy – Giant-cell myocarditis 1st line therapy Non-severe: prednisone 1 mg/kg/day p.o. then tapered Severe: i.v. methylprednisolone 7–14 mg/kg/day for 3 days, then 1 mg/kg/day p.o. + immunosuppressive

(azathioprinea or mycophenolate mofetilb, cyclosporinec)

2nd line therapy Antithymocyte Globulin (ATG)g cyclophosphamideh, rituximabi 3rd line therapy – Cardiac sarcoidosis 1st line therapy Non-severe: prednisone 1 mg/kg/day p.o., tapering from 40–60 mg daily

Severe: i.v. methylprednisolone 7–14 mg/kg/day for 3 days, then 1 mg/kg/day p.o.

2nd line therapy Methotrexated (1st choice), or azathioprinea mycophenolate mofetilb, cyclophosphamideh 3rd line therapy Infliximabj or adalimumabk, rituximabi Lyme carditis 1st line therapy (a) Oral antibiotics (mild cases):

– Doxycycline 100 mg b.i.d. (14–21 days) – Amoxicillin 500 mg t.i.d. (14–21 days) – Cefuroxime axetil 500 mg b.i.d. (14–21 days) (b) i.v. antibiotics (severe cases):

– Ceftriaxone 2 g/day (14–21 days)

2nd line therapy i.v. antibiotics: Cefotaxime (2 g q8h × 14–21 days) or Penicillin G (18–24 MU/day i.v. q4h × 14–21 day) 3rd line therapy – Chagas disease 1st line therapy Benznidazole 5–7 mg/kg/day in 2 doses for 60 days

Nifurtimox 8–10 mg/kg/day in 3 doses for 60–90 days

2nd line therapy – 3rd line therapy –

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