Abstract
A 17-year-old female, who was previously fit and well with no preexisting health conditions, presented with a four-day history of worsening shortness of breath and diarrhoea. She had recent close contact with a relative diagnosed with COVID-19. On clinical examination, she was drowsy, hypotensive, tachycardic, tachypnoeic, and pyrexial. Her blood tests showed elevated inflammatory markers and lymphopenia. She underwent a transthoracic echocardiogram, which confirmed a severely impaired left ventricular (LV) systolic function with an ejection fraction of 35%. An initial impression of acute viral myocarditis was made. Three separate polymerase chain reaction (PCR) tests for SARS-CoV-2 RNA were performed, but they all returned negative. The patient was not responding to initial therapy. Therefore, the regional paediatrics hospital was consulted, and a diagnosis of paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS) was made, based on similar regional presentations. The patient was administered IV immunoglobulin therapy, to which she responded very well. Following a five-day hospital stay, the patient was discharged home as medically stable. A repeat transthoracic echocardiogram (TTE) showed recovery of the LV systolic function to 62%. Few cases have been reported on myocardial involvement in young patients with PIMS-TS. This case report highlights the initial presentation, medical care, and clinical course of this patient.
Highlights
The SARS-CoV-2 is responsible for causing the COVID-19, which was declared a global pandemic by the WHO on 11 March 2020 [1]
Several cardiovascular complications of COVID-19 have been described in the adult population, and acute myocarditis appears to be relatively frequent [3]
We report the initial presentation, medical care, and clinical course of a 17-year-old girl who presented with acute myocarditis secondary to PIMS-TS
Summary
The SARS-CoV-2 is responsible for causing the COVID-19, which was declared a global pandemic by the WHO on 11 March 2020 [1]. A 17-year-old female of Afro-Caribbean ethnicity presented to the ED at our district general hospital with no past medical history of note or cardiovascular risk factors She reported contact with her grandmother on May 1, 2020, who had been confirmed as COVID-19 positive on April 25, 2020. The patient had no recent travel history and reported no possibility of pregnancy She was unvaccinated against COVID-19 infection as she presented prior to the development of any global vaccinations. Due to the clinical presentation, the patient was discussed with the local cardiology team They advised a formal echocardiogram (ECHO) to be conducted to investigate suspected acute viral myocarditis. The patient was commenced on IV immunoglobulin (IVIG) at 2 grams per kilogram (g/kg) over 18 hours and low-dose aspirin 75 mg once daily She was not considered for angiotensin-converting enzyme inhibitor therapy in view of the acute phase of the syndrome. The case was discussed with the paediatric team, and it was decided that no further follow-up of the patient was required
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