First case of COVID-19 complicated with fulminant myocarditis: a case report and insights
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CASE REPORT
First case of COVID‑19 complicated with fulminant myocarditis: a case report and insights Jia‑Hui Zeng1 · Ying‑Xia Liu2 · Jing Yuan3 · Fu‑Xiang Wang3 · Wei‑Bo Wu3 · Jin‑Xiu Li4 · Li‑Fei Wang5 · Hong Gao6 · Yao Wang1 · Chang‑Feng Dong1 · Yi‑Jun Li1 · Xiao‑Juan Xie1 · Cheng Feng1 · Lei Liu2 Received: 6 February 2020 / Accepted: 5 April 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
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 groundglass 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 COVID19 needs further study. Keywords COVID-19 · Coronavirus · Fulminant myocarditis · Infection · Echocardiography
* Cheng Feng chaosheng‑[email protected]
4
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
5
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
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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
* Lei Liu [email protected] 1
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
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