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First case of COVID-19 complicated with fulminant myocarditis: a case report and insights.
Infection. 2020 Oct; 48(5):773-777.I

Abstract

BACKGROUND

Coronavirus disease 2019 (COVID-19) has been demonstrated to be the cause of pneumonia. Nevertheless, it has not been reported as the cause of acute myocarditis or fulminant myocarditis.

CASE PRESENTATION

A 63-year-old male was admitted with pneumonia and cardiac symptoms. He was genetically confirmed as having COVID-19 according to sputum testing on the day of admission. He also had elevated troponin I (Trop I) level (up to 11.37 g/L) and diffuse myocardial dyskinesia along with a decreased left ventricular ejection fraction (LVEF) on echocardiography. The highest level of interleukin-6 was 272.40 pg/ml. Bedside chest radiographs showed typical ground-glass changes indicative of viral pneumonia. Laboratory test results for viruses that cause myocarditis were all negative. The patient conformed to the diagnostic criteria of the Chinese expert consensus statement for fulminant myocarditis. After receiving antiviral therapy and mechanical life support, Trop I was reduced to 0.10 g/L, and interleukin-6 was reduced to 7.63 pg/mL. Moreover, the LVEF of the patient gradually recovered to 68%. The patient died of aggravation of secondary infection on the 33rd day of hospitalization.

CONCLUSION

COVID-19 patients may develop severe cardiac complications such as myocarditis and heart failure. This is the first report of COVID-19 complicated with fulminant myocarditis. The mechanism of cardiac pathology caused by COVID-19 needs further study.

Authors+Show Affiliations

Department of Medical Ultrasonics, National Clinical Research Center for Infectious Disease, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, No. 29 Bulan Road, Shenzhen, 518112, People's Republic of China.National Clinical Research Center for Infectious Disease, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, China.Department of Infectious Disease, National Clinical Research Center for Infectious Disease, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, China.Department of Infectious Disease, National Clinical Research Center for Infectious Disease, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, China.Department of Infectious Disease, National Clinical Research Center for Infectious Disease, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, China.Department of Intensive Care Unit, National Clinical Research Center for Infectious Disease, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, China.Department of Radiology, National Clinical Research Center for Infectious Disease, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, China.Department of Cardiology, National Clinical Research Center for Infectious Disease, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, China.Department of Medical Ultrasonics, National Clinical Research Center for Infectious Disease, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, No. 29 Bulan Road, Shenzhen, 518112, People's Republic of China.Department of Medical Ultrasonics, National Clinical Research Center for Infectious Disease, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, No. 29 Bulan Road, Shenzhen, 518112, People's Republic of China.Department of Medical Ultrasonics, National Clinical Research Center for Infectious Disease, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, No. 29 Bulan Road, Shenzhen, 518112, People's Republic of China.Department of Medical Ultrasonics, National Clinical Research Center for Infectious Disease, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, No. 29 Bulan Road, Shenzhen, 518112, People's Republic of China.Department of Medical Ultrasonics, National Clinical Research Center for Infectious Disease, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, No. 29 Bulan Road, Shenzhen, 518112, People's Republic of China. chaosheng-01@szsy.sustech.edu.cn.National Clinical Research Center for Infectious Disease, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, China. liulei3322@aliyun.com.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

32277408

Citation

Zeng, Jia-Hui, et al. "First Case of COVID-19 Complicated With Fulminant Myocarditis: a Case Report and Insights." Infection, vol. 48, no. 5, 2020, pp. 773-777.
Zeng JH, Liu YX, Yuan J, et al. First case of COVID-19 complicated with fulminant myocarditis: a case report and insights. Infection. 2020;48(5):773-777.
Zeng, J. H., Liu, Y. X., Yuan, J., Wang, F. X., Wu, W. B., Li, J. X., Wang, L. F., Gao, H., Wang, Y., Dong, C. F., Li, Y. J., Xie, X. J., Feng, C., & Liu, L. (2020). First case of COVID-19 complicated with fulminant myocarditis: a case report and insights. Infection, 48(5), 773-777. https://doi.org/10.1007/s15010-020-01424-5
Zeng JH, et al. First Case of COVID-19 Complicated With Fulminant Myocarditis: a Case Report and Insights. Infection. 2020;48(5):773-777. PubMed PMID: 32277408.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - First case of COVID-19 complicated with fulminant myocarditis: a case report and insights. AU - Zeng,Jia-Hui, AU - Liu,Ying-Xia, AU - Yuan,Jing, AU - Wang,Fu-Xiang, AU - Wu,Wei-Bo, AU - Li,Jin-Xiu, AU - Wang,Li-Fei, AU - Gao,Hong, AU - Wang,Yao, AU - Dong,Chang-Feng, AU - Li,Yi-Jun, AU - Xie,Xiao-Juan, AU - Feng,Cheng, AU - Liu,Lei, Y1 - 2020/04/10/ PY - 2020/02/06/received PY - 2020/04/05/accepted PY - 2020/4/12/pubmed PY - 2020/10/8/medline PY - 2020/4/12/entrez KW - COVID-19 KW - Coronavirus KW - Echocardiography KW - Fulminant myocarditis KW - Infection SP - 773 EP - 777 JF - Infection JO - Infection VL - 48 IS - 5 N2 - BACKGROUND: Coronavirus disease 2019 (COVID-19) has been demonstrated to be the cause of pneumonia. Nevertheless, it has not been reported as the cause of acute myocarditis or fulminant myocarditis. CASE PRESENTATION: A 63-year-old male was admitted with pneumonia and cardiac symptoms. He was genetically confirmed as having COVID-19 according to sputum testing on the day of admission. He also had elevated troponin I (Trop I) level (up to 11.37 g/L) and diffuse myocardial dyskinesia along with a decreased left ventricular ejection fraction (LVEF) on echocardiography. The highest level of interleukin-6 was 272.40 pg/ml. Bedside chest radiographs showed typical ground-glass changes indicative of viral pneumonia. Laboratory test results for viruses that cause myocarditis were all negative. The patient conformed to the diagnostic criteria of the Chinese expert consensus statement for fulminant myocarditis. After receiving antiviral therapy and mechanical life support, Trop I was reduced to 0.10 g/L, and interleukin-6 was reduced to 7.63 pg/mL. Moreover, the LVEF of the patient gradually recovered to 68%. The patient died of aggravation of secondary infection on the 33rd day of hospitalization. CONCLUSION: COVID-19 patients may develop severe cardiac complications such as myocarditis and heart failure. This is the first report of COVID-19 complicated with fulminant myocarditis. The mechanism of cardiac pathology caused by COVID-19 needs further study. SN - 1439-0973 UR - https://www.unboundmedicine.com/medline/citation/32277408/First_case_of_COVID_19_complicated_with_fulminant_myocarditis:_a_case_report_and_insights_ L2 - https://doi.org/10.1007/s15010-020-01424-5 DB - PRIME DP - Unbound Medicine ER -