Cardiogenic shock complicating multisystem inflammatory syndrome following COVID-19 infection: a case report.
BMC Cardiovasc Disord
; 21(1): 522, 2021 10 29.
Article
in English
| MEDLINE | ID: covidwho-1486551
ABSTRACT
BACKGROUND:
With the high prevalence of COVID-19 infections worldwide, the multisystem inflammatory syndrome in adults (MIS-A) is becoming an increasingly recognized entity. This syndrome presents in patients several weeks after infection with COVID-19 and is associated with thrombosis, elevated inflammatory markers, hemodynamic compromise and cardiac dysfunction. Treatment is often with steroids and intravenous immunoglobulin (IVIg). The pathologic basis of myocardial injury in MIS-A, however, is not well characterized. In our case report, we obtained endomyocardial biopsy that revealed a pattern of myocardial injury similar to that found in COVID-19 cardiac specimens. CASE PRESENTATION A 26-year-old male presented with fevers, chills, headache, nausea, vomiting, and diarrhea 5 weeks after his COVID-19 infection. His SARS-CoV-2 PCR was negative and IgG was positive, consistent with prior infection. He was found to be in cardiogenic shock with biventricular failure, requiring inotropes and diuretics. Given concern for acute fulminant myocarditis, an endomyocardial biopsy (EMB) was performed, showing an inflammatory infiltrate consisting predominantly of interstitial macrophages with scant T lymphocytes. The histologic pattern was similar to that of cardiac specimens from COVID-19 patients, helping rule out myocarditis as the prevailing diagnosis. His case was complicated by persistent hypoxemia, and a computed tomography scan revealed pulmonary emboli. He received IVIg, steroids, and anticoagulation with rapid recovery of biventricular function.CONCLUSIONS:
MIS-A should be considered as the diagnosis in patients presenting several weeks after COVID-19 infection with severe inflammation and multi-organ involvement. In our case, EMB facilitated identification of MIS-A and guided therapy. The patient's biventricular function recovered with IVIg and steroids.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Shock, Cardiogenic
/
Systemic Inflammatory Response Syndrome
/
COVID-19
/
COVID-19 Drug Treatment
/
Anticoagulants
/
Myocarditis
Type of study:
Case report
/
Diagnostic study
/
Observational study
/
Prognostic study
Topics:
Long Covid
Limits:
Adult
/
Humans
/
Male
Language:
English
Journal:
BMC Cardiovasc Disord
Journal subject:
Vascular Diseases
/
Cardiology
Year:
2021
Document Type:
Article
Affiliation country:
S12872-021-02304-Y
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