Focal Myocarditis As the First Sign in the Presentation of a COVID-19 Infection: A Case Report

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). Patients with COVID-19 typically present with symptoms and signs related to respiratory tract infection. However, a broad spectrum of cardiac manifestations including myocarditis has been reported as complications of this virus. Nevertheless, focal myocarditis as the first clinical manifestation of COVID-19 infection has not been reported before. Thus, we herein present the case of a 56-year-old male patient previously healthy and presented to the emergency department with chest pain. The clinical picture was compatible with inferior ST-elevation myocardial infarction (STEMI). Initial COVID-19 polymerase chain reaction (PCR) was negative, as well for its classic symptoms. Thereafter, further investigations suggested the diagnosis of focal myocarditis. Later on, the patient started to have a fever and repeated COVID-19 PCR that returned positive.