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Fulminant myocarditis: COVID or not COVID? Reinfection or co-infection?

Ramya Yeleti1,2, Maya Guglin3, Kashif Saleem4

  • 1College of Osteopathic Medicine, Marion University, 3200 Cold Spring Rd, Indianapolis, IN 46222, USA.

Future Cardiology
|February 22, 2021
PubMed

Insights

A patient with presumed SARS-CoV-2 reinfection developed fulminant myocarditis, potentially triggered by a co-infection with Parvovirus. This case highlights a rare cause of severe heart inflammation and rapid recovery.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Virology

Background:

  • Fulminant myocarditis is a severe form of heart muscle inflammation.
  • SARS-CoV-2 (the virus causing COVID-19) has been associated with cardiac complications.
  • Viral co-infections can complicate the presentation and management of myocarditis.

Observation:

  • A patient with a history of COVID-19 and detectable antibodies presented with fulminant myocarditis.
  • Endomyocardial biopsy revealed lymphocytic myocarditis, with positive molecular testing for Parvovirus but negative for SARS-CoV-2.
  • The patient experienced hemodynamic instability, requiring mechanical circulatory support with VA ECMO and Impella CP.

Findings:

  • The case suggests a potential co-infection of SARS-CoV-2 and Parvovirus as a trigger for fulminant myocarditis.
  • Lymphocytic myocarditis was confirmed histologically.
  • Rapid recovery of left ventricular function was observed within 48 hours.

Implications:

  • This case underscores the importance of considering co-infections in severe myocarditis, even with prior SARS-CoV-2 exposure.
  • Parvovirus co-infection may play a role in SARS-CoV-2-associated cardiac injury.
  • Prompt mechanical circulatory support and potential targeted therapy can lead to favorable outcomes in fulminant myocarditis.

Keywords:
SARS-CoV-2VA ECMOcardiogenic shockcoronavirus disease-19fulminant myocarditis

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