Key result
Anakinra prompts complete biventricular recovery in COVID-19 myocarditis with cardiogenic shock, restoring LVEF to ~55%.
Why the study?
COVID-19-related myocarditis and cardiogenic shock present diagnostic, histological, and treatment challenges that require detailed characterization.
Case Report (n=1)
No
May support IL-1 inhibition in refractory COVID-19 myocarditis shock; hypothesis-generating and requires randomized confirmation.
BACKGROUND: The year 2020 was dramatically characterized by SARS-CoV-2 pandemic outbreak. COVID-19-related heart diseases and myocarditis have been reported. CASE SUMMARY: A 45-year-old healthy male was admitted to the intensive care unit of our hospital because of cardiogenic shock. A diagnosis of COVID-19 infection and myocarditis was done. We present here several peculiarities about diagnostic workup, myocardial histological findings, choice of treatment, and the patient clinical course at 3 and 8 months of follow-up. DISCUSSION: COVID-19 myocardial damage and myocarditis are mainly linked to the cytokine storm with mild myocardial inflammatory infiltrate and very unusual platelet microclots in the setting of the microvascular obstructive thrombo-inflammatory syndrome. Counteracting the inflammatory burden with an interleukine-1 inhibitor appeared safe and led to a dramatic and stable improvement of cardiac function.
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Fiore et al. (2021) conducted a case report in COVID-19 myocarditis with cardiogenic shock (n=1). Anakinra was evaluated on Left ventricular ejection fraction (LVEF) recovery. Treatment with the IL-1 inhibitor Anakinra in a patient with COVID-19 myocarditis and cardiogenic shock led to complete recovery of biventricular function, with LVEF improving from 25% to 55%.
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