Houshmand, G.

Mahdavi, M.

Mortaz Hejri, G.

Pouraliakbar, H.

eprints Iran University of Medical Sciences

CARDIOVASCULAR FLASHLIGHT doi:10.1093/eurheartj/ehaa1028....................................................................................................................................................Delayed diffuse inflammatory myocardial damage in a child with a historyof systemic inflammatory syndrome related to COVID-19Mohammad Mahdavi, Golnaz Houshmand , Hamidreza Pouraliakbar, and Golnar Mortaz Hejri*Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Valiasr St, Niayesh Blv, P.O. 1965833453, Tehran, Iran* Corresponding author. Tel: 19823923753, Email: gmortaz.h@gmail.comA 4-year-old girl presented to the emer-gency unit with respiratory distress andtachycardia. She had a history of admis-sion due to COVID-19 related systemicinflammatory syndrome. The real -timepolymerase chain reaction (RT-PCR) forSARS-COV2 had been positive, and 2weeks before, she was discharged withgood condition and preserved left ven-tricular function. At the current admis-sion, she was afebrile, the blood pressure90 mmHg/pulse, heart rate 140 b.p.m.,respiratory rate 40 breath/min, and theO2 saturation was 92% in room air. Thepoint of care echocardiography revealedsevere left and right ventricular dysfunc-tion with bilateral pleural effusion.Blood tests showed leucocytosis whiteblood cells (WBC) 17.7 109/L polymor-phonuclear (PMN) 70% lymphocyte 25%,elevated cardiac and inflammatorymarkers, troponin I 3.5mg/L (<0.03mg/L),proBNP 8827 pg/mL, ferritin 683 ng/dL,and c-reactive protein (CRP) 40 mg/L.The SARS-COV2 RT-PCR returned nega-tive, but the IgG for SARS-COV2 waspositive.Chest CT showed lung congestionswith bilateral moderate pleural effusion.The cardiac magnetic resonance on the second day showed enlarged biventricular sizes and severely reduced ejection fractions left ventric-ular ejection fraction (LVEF)¼ 10%, right ventricular ejection fraction (RVEF)¼ 16% (Supplementary material online, Video S1) T2 weightedimages showed diffuse oedema (Panels A and B). Late gadolinium enhancement images showed diffused nearly transmural myocardial injuryin the left and right ventricle with a spared basal septum and small left ventricular thrombosis (Panels C and D). The computed tomography(CT) angiography revealed normal coronary arteries.The diagnosis of fulminant myocarditis was made and treatment initiated with steroid, intravenous immunoglobulin, and anticoagulation.She was transferred to the paediatric intensive care unit on Day 3 because of haemodynamic worsening and was put on mechanical ventila-tion and vasopressors. She was non-responsive to the medical treatment, and unfortunately, she died due to refractory cardiac failure after3 weeks.Supplementary material is available at European Heart Journal online.Conflict of interest: The authors have submitted their declaration which can be found in the article Supplementary Material online.Published on behalf of the European Society of Cardiology. All rights reserved. VC The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.

Delayed diffuse inflammatory myocardial damage in a child with a history of systemic inflammatory syndrome related to COVID-19

http://eprints.iums.ac.ir/39517/1/Delayed%20diffuse%20inflammatory%20myocardial%20damage%20in%20a%20child%20with%20a%20history%20of%20systemic%20inflammatory%20syndrome%20related%20to%20COVID-19.pdf

Delayed diffuse inflammatory myocardial damage in a child with a history of systemic inflammatory syndrome related to COVID-19

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eprints Iran University of Medical Sciences