Numerous drugs and chemicals cause myocarditis. In some cases, these agents directly damage myocytes. Leak of intracellular contents into the interstitium induces inflammation and may also initiate a secondary autoimmune process. Other mechanisms undoubtedly exist. A hypersensitivity response to drugs and chemicals can be distinguished from direct toxicity by the presence of eosinophils. In either case, the most effective treatment is removal of the offending agent. Addition of corticosteroids may help when inflammation is unusually severe, ventricular dysfunction is markedly depressed, or recovery is delayed.
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