Myocarditis and coronary aneurysms in a child with acute respiratory syndrome coronavirus 2

Area of Science:

• Pediatric Cardiology
• Infectious Diseases
• Critical Care Medicine

Background:

• A 6-year-old boy presented with persistent fever, respiratory distress, and signs of myocarditis.
• The patient had a multi-viral infection, including parvovirus B19 and SARS-CoV-2.
• Complications included cardiogenic shock, coronary aneurysms, and suspected macrophage activation syndrome.

Observation:

• The patient required ventilatory and inotropic support for cardiogenic shock.
• Treatment involved intravenous immunoglobulins, aspirin, diuretics, dexamethasone, hydroxychloroquine, and low molecular weight heparin.
• Cardiac function and coronary artery dimensions normalized within days of treatment initiation.

Findings:

• Cardiac magnetic resonance imaging 20 days post-hospitalization showed mild myocardial interstitial edema without focal necrosis.
• These findings suggest cardiac stunning induced by a cytokine storm rather than direct viral injury to cardiomyocytes.
• The multi-viral infection triggered a significant inflammatory response impacting cardiac function.

Implications:

• This case highlights the potential for severe cardiac complications in children with multi-viral infections.
• It underscores the importance of early recognition and management of cytokine storm-mediated cardiac dysfunction.
• Understanding the pathophysiology is crucial for developing targeted therapeutic strategies in pediatric critical care.