SARS-CoV 2 Virus Causing Fulminant Myocarditis: A Rare but Serious Complication of COVID-19 Infection

Abstract

The COVID-19 pandemic has been one that has brought widespread suffering and grief throughout the world; and the complications associated-both short and long term have been widespread and autonomous. We present a case of a 68-year-old White Hispanic male who presented to the emergency department with worsening exertional dyspnea and fatigue eight days after testing positive for SARS-CoV-2. On arrival the patient was afebrile, hypotensive, tachycardic, tachypneic and hypoxemic. Initial workup was significant for high elevated inflammatory markers, troponin and β-natriuretic peptide. EKG was unremarkable. Transthoracic echocardiogram revealed severe global hypokinesis of the left ventricle, reduced ejection fraction of 25%-30%, grade II diastolic dysfunction, mild pulmonary hypertension and mild elevated right atrial pressures, and no pericardial effusion. PCR analysis for usual cardiotropic viruses were all negative, Antinuclear antibody (ANA) was negative, therefore the patient was diagnosed with fulminant COVID-19 myocarditis. Patient was treated with heparin drip, oxygen support, pressors, and high dose corticosteroid therapy in the intensive care unit for 5 days. After showing significant signs of improvement, the patient was discharged on hospital stay day 7. Cardio-respiratory complications are the leading cause of morbidity and mortality in terms of patients suffering with COVID-19. In this case we discuss the importance of early diagnosis and prompt management to reduce the high mortality and complications associated with these complications.