Cardiogenic Shock Caused by SARS-CoV-2 in a Patient with Serial Negative Nucleic Acid Amplification Tests. Case Report
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COVID-19
Cardiogenic Shock Caused by SARS-CoV-2 in a Patient with Serial Negative Nucleic Acid Amplification Tests. Case Report Aina Gomila-Grange 1
&
M. Espasa 2 & E. Moglia 3
Accepted: 27 August 2020 # Springer Nature Switzerland AG 2020
Abstract Myocarditis is an unusual manifestation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It has been associated with increased severity of disease and mortality. The diagnosis of coronavirus disease 2019 (COVID-19) is based on positivity of nucleic acid amplification tests (NAAT) of respiratory samples. We report the case of a patient with cardiogenic shock caused by SARS-CoV-2 myocarditis with serial negative upper and lower respiratory nucleic acid amplification tests. Diagnosis was made by serology (positive IgM + IgA and IgG) from patient’s serum sample of day 10 after symptoms’ initiation. Keywords Severe acute respiratory syndrome coronavirus 2 . Coronavirus disease 2019 . Myocarditis . Serology
Introduction Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) emerged in Wuhan, China, in December 2019 and rapidly spread to different countries being declared a pandemic. It has caused more than 21 million infections and more than 700,000 deaths worldwide since its origin [1, 2]. Although respiratory symptoms are the most common manifestation of coronavirus disease 2019 (COVID-19), cardiovascular involvement has been described in up to 20% of hospitalized patients [3, 4]. Cardiac injury due to SARS-CoV-2 refers to blood levels of troponin I concentration above the upper reference limit and seems to be caused by a combination of direct viral myocardial interstitial damage and organ injury caused by the severe acute systemic inflammatory response triggered by the infection [5–7]. Arrhythmias and acute coronary syndrome may also occur in the context of hypoxemia, myocardial inflammation and thrombotic phenomena [8, 9]. In This article is part of the Topical Collection on Covid-19 * Aina Gomila-Grange [email protected] 1
Infectious Diseases Department, Consorci Corporació Sanitària Parc Taulí, Parc Taulí 1, Sabadell, 08208 Barcelona, CP, Spain
2
Microbiology Unit, Consorci Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain
3
Intensive Care Unit, Consorci Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain
different published studies, patients with myocardial involvement by COVID-19 usually had cardiovascular underlying conditions and showed worse prognosis, including increased risk of intensive care unit admission and mortality compared with those without cardiac injury. Myocarditis has been recognized as one of the most common forms of cardiac injury [4, 10–12]. Here, we report the case of a healthy man presenting with cardiogenic shock caused by SARS-CoV-2 myocarditis, without pneumonia, in whom nucleic acid amplification tests (NAAT) were repeatedly negative in upper and lower respiratory tract samples. Diagnosis of acute disease was made by positivity of serology.
Case Report A 39-year-old man original from Uruguay
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