Fulminant Myocarditis

To the Editor: In their study of fulminant myocarditis as compared with acute (nonfulminant) myocarditis, McCarthy et al. (March 9 issue)¹ included all patients in whom the diagnosis was established by endomyocardial biopsy and who met their selection criteria. However, by not incorporating diagnoses established at autopsy, the authors introduced a selection bias in favor of a better outcome of fulminant myocarditis. Excluding cases with a rapidly fatal onset essentially reduces the study to a comparison of patients with acute myocarditis and early survivors of fulminant myocarditis.In several autopsy series,²⁴ fulminant myocarditis was found to be a prominent . . .