Delayed acute myocarditis and COVID‐19‐related multisystem inflammatory syndrome

Autor: Patrick Henry, Patrice Cacoub, Damien Logeart, Mathilde Baudet, Yoram Nahmani, Homa Adle-Biassette, Alain Cohen-Solal, Martin Nicol, Lea Cacoub
Přispěvatelé: Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de médecine interne [CHU Pitié-Salpétrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Sorbonne Université - Faculté de Médecine (SU FM), Sorbonne Université (SU)
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Cardiac function curve
Pathology
medicine.medical_specialty
Myocarditis
Tonsillitis
Inflammation
Case Report
Case Reports
030204 cardiovascular system & hematology
Systemic inflammation
03 medical and health sciences
0302 clinical medicine
[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system
Cardiac magnetic resonance imaging
[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases
COVID‐19
medicine
Diseases of the circulatory (Cardiovascular) system
030212 general & internal medicine
[SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases
Ejection fraction
medicine.diagnostic_test
business.industry
COVID-19
Pathological analysis
medicine.disease
3. Good health
Heart failure
RC666-701
medicine.symptom
business
Cardiology and Cardiovascular Medicine
Zdroj: ESC Heart Failure
ESC Heart Failure, Wiley, In press, ⟨10.1002/ehf2.13047⟩
ESC Heart Failure, Vol 7, Iss 6, Pp 4371-4376 (2020)
ISSN: 2055-5822
Popis: International audience; Precise descriptions of coronavirus disease 2019 (COVID-19)-related cardiac damage as well as underlying mechanisms are scarce. We describe clinical presentation and diagnostic workup of acute myocarditis in a patient who had developed COVID-19 syndrome 1 month earlier. A healthy 40-year-old man suffered from typical COVID-19 symptoms. Four weeks later, he was admitted because of fever and tonsillitis. Blood tests showed major inflammation. Thoracic computed tomography was normal, and RT-PCR for SARS-CoV-2 on nasopharyngeal swab was negative. Because of haemodynamic worsening with both an increase in cardiac troponin and B-type natriuretic peptide levels and normal electrocardiogram, acute myocarditis was suspected. Cardiac echographic examination showed left ventricular ejection fraction at 45%. Exhaustive diagnostic workup included RT-PCR and serologies for infectious agents and autoimmune blood tests as well as cardiac magnetic resonance imaging and endomyocardial biopsies. Cardiac magnetic resonance with T2 mapping sequences showed evidence of myocardial inflammation and focal lateral subepicardial late gadolinium enhancement. Pathological analysis exhibited interstitial oedema, small foci of necrosis, and infiltrates composed of plasmocytes, T-lymphocytes, and mainly CD163+ macrophages. These findings led to the diagnosis of acute lympho-plasmo-histiocytic myocarditis. There was no evidence of viral RNA within myocardium. The only positive viral serology was for SARS-CoV-2. The patient and his cardiac function recovered in the next few days without use of anti-inflammatory or antiviral drugs. This case highlights that systemic inflammation associated with acute myocarditis can be delayed up to 1 month after initial SARS-CoV-2 infection and can be resolved spontaneously.
Databáze: OpenAIRE
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