ORIGINAL ARTICLE Short-Term Outcomes of Acute Fulminant Myocarditis in Children Jhuma Sankar • Sumaira Khalil • M. Jeeva Sankar • Dinesh Kumar • Nandkishore Dubey Received: 10 February 2011 / Accepted: 20 April 2011 Ó Springer Science+Business Media, LLC 2011 Abstract Data on the clinical profile, echocardiographic findings, and outcome of acute fulminant myocarditis (AFM) in children from resource limited countries are limited. To study the clinical profile and short-term out- comes of children aged 2 months to 17 years with AFM managed with only supportive care. We enrolled all chil- dren admitted with AFM in our hospital from January 2009 to October 2010. Although the information on patients admitted from January 2009 to March 2010 were retrieved from the case records, data of children admitted from April 2010 were recorded prospectively. AFM was diagnosed based on clinical and echocardiographic criteria. We col- lected information regarding clinical course, treatment details, and echocardiography findings using a structured performa. All of the children, including those for whom baseline information was collected from the records, were followed-up prospectively to determine short-term out- comes. A total of 10 children, of whom 6 were male, presented with AFM. Their median age was 7.5 (inter- quartile range [IQR] 2 to13) years, and the mean left- ventricular ejection fraction (LVEF) was 26% (SD 11.5). Of the 10 children, 9 were discharged, and 1 child died. At discharge, all children showed improvement in the symp- toms, but only 4 had improvement in LV function on echocardiography. Factors associated with poor recovery of LV function at discharge were anasarca, low LVEF, and increased serum glutamate pyruvate transaminase levels at admission. One child had died at 2-month follow-up, and another child developed dilated cardiomyopathy at 15 months after discharge. Children with AFM had good immediate- and short-term outcomes even without the use of mechanical assist devices. Decreased LVEF at admis- sion was found to be one of the most important determi- nants of poor immediate outcomes in these children. Keywords Myocarditis Á Heart failure Á Cardiogenic shock Á Echocardiography Á Outcome Á Children Introduction Acute fulminant myocarditis (AFM) is a rare and distinct clinical entity characterized by sudden onset of severe congestive failure or cardiogenic shock after flu-like ill- ness. Although the exact incidence of AFM is unknown, it constitutes approximately 10 to 38% of all cases of acute myocarditis (AM) [2, 16]. Despite its fulminant presenta- tion, AFM has been reported to have relatively good short- term outcomes with either supportive therapy alone or with use of mechanical circulatory support and/or immunosup- pressive agents in addition to symptomatic therapy. Majority of the studies have been reported from developed countries [3, 9, 13, 16]. Data on the clinical courses, bio- logical profiles, and natural outcomes of children with AFM in developing countries is limited possibly due to the rarity of the condition, difficulty in differentiating AFM from a variety of respiratory and other cardiac conditions, and, more importantly, lack of timely referral to a tertiary care center [2]. Given the differences in the demographic, socioeconomic profile, and level of health care between the replete-resource and limited-resource settings, it is essen- tial to examine the short- and long-term outcomes of J. Sankar (&) Á S. Khalil Á D. Kumar Á N. Dubey Department of Pediatrics, PGIMER, Dr. Ram Manohar Lohia Hospital, New Delhi, India e-mail: jhumasankar@gmail.com M. Jeeva Sankar Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India 123 Pediatr Cardiol DOI 10.1007/s00246-011-0007-8