Chronic biopsy proven post‐COVID myoendocarditis with SARS‐Cov‐2 persistence and high level of antiheart antibodies

Figures

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  Figure 1. Echocardiography and magnetic resonance imaging in patients with post‐COVID myocarditis. Upper series—echocardiography: (A) decreased dp/dt (413 mmHg); (B) severe tricuspid regurgitation due to dilatation of the right ventricle; (C) vegetation on the bicuspid aortic valve measuring 3 × 5 mm (arrow), transesophageal study. Lower series—MRI: (D, F) late gadolinium enhancement in the posterior septal and posterior segments of the left ventricle (arrows); (E) edema along the posterior septal segment of the left ventricle (T2 map).

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  Figure 2. Endomyocardial biopsy of the right ventricle in patients with post‐COVID myocarditis. (A–G) Hematoxylin‐eosin staining: diffuse (A–D) and focal (G) infiltration with lymphocytes, giant multinucleated cells (B), eosinophils (D); cardiomyocyte necrosis with cytoplasm lysis, edema (A, B, D, G); areas of fatty replacement of the myocardium (C); endothelitis (E); microvascular thrombosis (G); fresh parietal thrombosis (F). (H) Van Gieson staining: diffuse perimuscular and perivascular sclerosis. (I) Immunohistochemical study with antibodies to the spike protein of SARS‐Cov‐2: positive reaction in vascular endothelium and infiltrate cells.

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  Figure 3. Immunohistochemical study of right ventricular myocardial biopsy specimens in patients with post‐COVID myocarditis. Diagnostically significant expression of CD45‐positive T‐lymphocytes (more than 14 cells per 1 mm2) and CD3‐positive T‐lymphocytes (more than 7 cells per 1 mm2). Various degrees of expression of CD68‐positive cells (macrophages) and CD20‐positive B‐lymphocytes.