Key Points
- Describe a clinical presentation of delayed or persistent active myocarditis identified weeks after clinical recovery from COVID-19 pneumonia.
- Clinical, laboratory, and multimodality cardiovascular imaging evaluation of a 31-year-old male presenting 3 weeks after recovery from confirmed SARS-CoV-2 pneumonia (N=1).
- Diagnostic workup included transthoracic echocardiography, serological testing for non-SARS-CoV-2 viral pathogens, and cardiac magnetic resonance (CMR) imaging with T2-weighted oedema and late gadolinium enhancement sequences.
- Laboratory testing showed normal high-sensitivity troponin T (<0.03 ng/mL) and low C-reactive protein (3.3 mg/L), with negative repeat SARS-CoV-2 RT–PCR and negative non-SARS-CoV-2 viral serology.
- Cardiac magnetic resonance demonstrated a mildly reduced left ventricular ejection fraction of 50%, mid inferoseptal and inferior myocardial oedema on T2-weighted imaging, and subepicardial fibrosis via late gadolinium enhancement indicative of active myocarditis.
Structured PICO
PPopulationA 31-year-old male with a history of COVID-19 pneumonia presenting with dyspnoea on exertion and low-grade fever 3 weeks after discharge.
IInterventionMedical treatment with bisoprolol and lisinopril
OOutcomeDiagnosis of active myocarditis via cardiac magnetic resonance imaging
This case highlights that active myocarditis can present as a residual complication following recovery from COVID-19 pneumonia and can be effectively detected using cardiac magnetic resonance.