[Post-Covid aortitis with cardiac involvement: progressive aortic aneurysm combined with active myocarditis]

The new coronavirus infection is characterized not only by pronounced cytokine and autoimmune reactions in the acute period, but is also an inducer of a whole spectrum of chronic immunoinflammatory conditions, which differ in varying degrees of specificity from general manifestations of the so-called post-COVID syndrome to single-organ diseases (including myocarditis) and nosologically defined systemic autoimmune diseases and vasculitis. Isolated post-COVID aortitis is one of the rarest complications of SARS-CoV-2 infection. We present a clinical observation of a patient with myocarditis and aortitis simultaneously developing 1 month after COVID-19 with damage to the infrarenal section and formation of an aortic aneurysm. Myocarditis was verified by MRI, manifested by severe dysfunction of the left ventricle with a drop in the ejection fraction to 30% and was of an autoimmune nature (a 4-fold increase in the titers of anticardiac antibodies was revealed). At the same time, MSCT revealed an aortic aneurysm with thickening of its walls. Therapy with medium doses of corticosteroids resulted in clinical remission of myocarditis, but progression of the aortic aneurysm required surgical treatment. The diagnosis of chronic immune inflammation associated with SARS-CoV-2 was morphologically confirmed (nucleocapsid and spike proteins of the virus were detected in macrophages, lymphocytes of infiltrates and endothelium of microvessels). The combination of post-COVID myocarditis and chronic aortitis has not been described previously. The issues of pathogenesis, diagnostics, and nosological nature of combined immune-inflammatory damage to the heart and blood vessels after a new coronavirus infection are discussed.