Inflammatory process of the COVID-19 fulminant myocarditis in the multimodality imaging: a case report

Area of Science:

• Cardiology
• Infectious Diseases
• Medical Imaging

Background:

• COVID-19 infection is linked to various cardiac manifestations, including fulminant myocarditis.
• Pathophysiology involves direct viral damage and immune-mediated myocardial inflammation.
• Multi-modality imaging is crucial for tracking inflammatory processes in COVID-19-associated myocarditis.

Observation:

• A 49-year-old male with COVID-19 experienced cardiac arrest due to severe left ventricular dysfunction and cardiac tamponade.
• Initial treatment with steroids, remdesivir, and tocilizumab was insufficient; recovery required pericardiocentesis and extracorporeal membrane oxygenation.
• Serial chest computed tomography (CT) and cardiac magnetic resonance (MR) imaging were performed over 145 days.

Findings:

• Early CT scans revealed intense pericardial inflammation.
• While non-MR imaging and chemical markers indicated improvement, cardiac MR demonstrated prolonged pericardial inflammation exceeding 50 days.
• Cardiac MRI revealed a significant inflammatory duration, underscoring its value in assessing long-term cardiac sequelae.

Implications:

• Persistent inflammation in COVID-19 myocarditis may require extended monitoring and management.
• Multi-modality imaging, particularly cardiac MRI, is essential for fully characterizing the extent and duration of cardiac inflammation post-COVID-19.
• Understanding the long-term inflammatory course is vital for patient recovery and preventing chronic cardiac complications.