Virus-negative necrotizing coronary vasculitis with aneurysm formation in human sars-cov-2 infection

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: SARS-CoV-2-associated myopericarditis with virus-negative necrotizing intramural coronary vasculitis and biventricular apical microaneurysms (n=1). Intervention: Prednisone and remdesivir plus ramipril and bisoprolol. Primary outcome: Resolution of cardiac inflammation, pericardial effusion, and ventricular arrhythmias at 1 month.

Q: What does this research mean for the field?

SARS-CoV-2 infection can cause virus-negative immune-mediated necrotizing coronary vasculitis of intramural vessels with microaneurysm formation, which responds to high-dose prednisone combined with antiviral therapy. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Frustaci A.; M. Francone; Verardo R.; M.R. Capobianchi; Chimenti C.

doi:10.3390/idr13030055

January 1, 2021

Virus-negative necrotizing coronary vasculitis with aneurysm formation in human sars-cov-2 infection

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Key result

Prednisone and remdesivir resolve cardiac inflammation and arrhythmias at 1 month in SARS-CoV-2 coronary vasculitis.

n=1

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Key Points

To describe a case of SARS-CoV-2-associated myopericarditis presenting with necrotizing coronary vasculitis of intramural vessels and determine its underlying mechanism.
Evaluated a 50-year-old female presenting with angina, palpitations, elevated cardiac troponin HS, and non-sustained ventricular tachycardia following confirmed SARS-CoV-2 infection.
Conducted cardiac magnetic resonance imaging, coronary angiography, and left ventricular endomyocardial biopsy.
Analyzed endomyocardial tissue via histology, immunohistochemistry, and real-time polymerase chain reaction for SARS-CoV-2 and common cardiotropic viruses.
Endomyocardial biopsy showed diffuse mononuclear infiltrates, myocyte necrosis, necrotizing vasculitis of intramural coronary arteries positive for CD45RO+ T-lymphocytes, and complement C3d deposition despite normal epicardial arteries.
Real-time polymerase chain reaction for SARS-CoV-2 and common cardiotropic viruses was negative in myocardial tissue, demonstrating an immune-mediated inflammatory process.
Therapy with high-dose prednisone (1 mg/Kg daily) and remdesivir resolved ventricular arrhythmias, normalized cardiac troponin HS and C-reactive protein, and cleared pericardial effusion at 1-month follow-up.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

1 50-year-old female with SARS-CoV-2-associated virus-negative myopericarditis, necrotizing intramural coronary vasculitis, and biventricular apical microaneurysms, followed for 1 month.

I

Intervention

High-dose prednisone (1 mg/Kg daily), remdesivir, ramipril, and bisoprolol

O

Outcome

Resolution of cardiac inflammation (normalization of C-reactive protein and troponin HS, resolution of pericardial effusion) and control of ventricular arrhythmias at 1 month follow-up

This case report provides the first evidence of virus-negative, immune-mediated necrotizing intramural coronary vasculitis with microaneurysm formation in SARS-CoV-2 myopericarditis, which resolved following endomyocardial biopsy-guided high-dose steroid and antiviral therapy.

Limitations

Single-patient case report design

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Implication

May support biopsy-guided steroids plus remdesivir in rare SARS-CoV-2 vasculitis; hypothesis-generating and should not change practice.

Abstract

We report a case of myopericarditis associated to SARS-CoV-2 infection with necrotizing coronary vasculitis of intramural vessels, giving rise to biventricular apical microaneurysms and to electrical instability. Negativity of myocardial polymerase chain reaction for the most common cardiotropic viruses and for SARS-CoV-2 suggested an immune-mediated myocardial and pericardial inflammatory disease. High dose (1 mg/Kg daily) prednisone and anti-viral (Remdesivir, IDA Business, Carrigtohill, County Cork, T45 DP77, Ireland) therapy led to resolution of cardiac inflammation and ventricular arrhythmias. Morpho-molecular characterization of endomyocardial tissue may improve the outcome in subjects with SARS-CoV-2-associated myopericarditis and coronary vasculitis.

Discussion

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Cite This Study

A. et al. (2021) conducted a case report in SARS-CoV-2-associated myopericarditis with virus-negative necrotizing intramural coronary vasculitis and biventricular apical microaneurysms (n=1). Prednisone and remdesivir plus ramipril and bisoprolol was evaluated on Resolution of cardiac inflammation, pericardial effusion, and ventricular arrhythmias at 1 month. Prednisone (1 mg/kg daily) and remdesivir resolved cardiac inflammation, pericardial effusion, and ventricular arrhythmias at 1 month in a patient with SARS-CoV-2 coronary vasculitis.

synapsesocial.com/papers/6aa9017deed42882c1fc195c https://doi.org/10.3390/idr13030055

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Virus-negative necrotizing coronary vasculitis with aneurysm formation in human sars-cov-2 infection

Figures

Key Points

Study Design

Structured PICO

Limitations

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Implication

Abstract

Discussion

Cite This Study

Virus-negative necrotizing coronary vasculitis with aneurysm formation in human sars-cov-2 infection

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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