Subtype-Specific Treatment of Autoimmune Myocarditis

Autoimmune myocarditis presents a distinct therapeutic challenge: similar clinical syndromes may arise from fundamentally different immune mechanisms and therefore require different treatments. This narrative review synthesizes current evidence for the management of giant cell myocarditis, eosinophilic myocarditis, cardiac sarcoidosis, systemic autoimmune disease-associated myocarditis, immune checkpoint inhibitor-associated myocarditis, and virus-negative immune-mediated lymphocytic myocarditis. We examine how clinical severity, histopathology, infectious exclusion, extracardiac disease, and treatment toxicity shape therapeutic decisions. Although cardiovascular stabilization follows shared principles, immunosuppressive strategies vary substantially across subtypes, ranging from corticosteroids and multidrug immunosuppression to targeted biologic or molecular therapies. We also discuss treatment escalation, monitoring response, and management of fulminant presentations. Across all subtypes, the central challenge is balancing the urgency of suppressing myocardial inflammation against diagnostic uncertainty and treatment-related risk. A subtype-directed approach offers the most clinically meaningful framework for selecting therapy and improving consistency in the management of autoimmune myocarditis.