Key result
A 39-year-old female with Delta variant COVID-19 developed fatal fulminant myocarditis and primary cardiac dysfunction without respiratory compromise, unresponsive to mechanical support.
Why the study?
Profound primary cardiac dysfunction requiring mechanical circulatory support with fulminant myocarditis prior to respiratory failure is rarely described in COVID-19, with seldom-reported endomyocardial biopsy findings and unknown effective treatment.
Case Report (n=1)
Highlights a rare, severe case of fulminant primary cardiac dysfunction due to Delta COVID-19 myocarditis without respiratory failure, which proved fatal despite aggressive mechanical and medical support.
Alerts to possible primary cardiac failure before respiratory failure in COVID-19; leaves open optimal EMB-guided management.
Background: Whilst myocarditis or myocardial injury due to severe acute respiratory syndrome coronavirus 2 infection is commonly reported, profound primary cardiac dysfunction requiring mechanical circulatory support, with the development of fulminant myocarditis prior to respiratory failure, is rarely described. The endomyocardial biopsy (EMB) findings in these patients is seldom reported, the findings are varied, and effective treatment unknown. Case summary: A 39-year-old female with no significant past medical history and confirmed Delta variant coronavirus disease 2019 (COVID-19) infection (Day 3), presented with a 1 day history of diarrhoea, vomiting, and abdominal pain. The patient denied respiratory symptoms and chest X-ray was clear. Lactate level was 6.3, initial troponin T 118 ng/L. Despite resuscitation, the patient significantly deteriorated in the emergency department, resulting in pulseless electrical activity arrest requiring veno-arterial extra-corporeal membrane oxygenation cardiopulmonary resuscitation. Over the following 36 h, cardiac function deteriorated to near-complete left ventricular (LV) standstill. Coronary angiography revealed normal coronary arteries with slow flow. Endomyocardial biopsy showed diffuse interstitial macrophage infiltrate and small vessel thromboses. Left ventricular function did not improve over the following 7 days, and despite treatment with tocilizumab, high-dose steroids, and intravenous immunoglobulin, she eventually died due to disease-related complications. Discussion: Primary cardiac dysfunction secondary to COVID-19 infection is rarely reported. Little is known about the incidence, natural history, and pathophysiology of fulminant COVID-19 myocarditis. We present the most severe case of cardiac dysfunction due to COVID-19 reported in a young patient without respiratory compromise who never recovered from any cardiac function.
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Thomson et al. (2022) conducted a case report in Fulminant Delta COVID-19 myocarditis (n=1). Delta variant COVID-19 infection was evaluated on Clinical outcome. A 39-year-old female with Delta variant COVID-19 developed fatal fulminant myocarditis and primary cardiac dysfunction without respiratory compromise, unresponsive to mechanical support.
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