Hussain Hussain, Fadel Aya, Alwaeli Haidar, Guardiola Victor
Internal Medicine, Cardiology Clinic, Pasadena, USA.
Internal Medicine, Florida International University, Hialeah Hospital, Miami, USA.
Cureus. 2020 Jun 24;12(6):e8808. doi: 10.7759/cureus.8808.
Myopericarditis remains a prominent infectious inflammatory disorder throughout a patient's lifetime. Moreover, viral pathogens have been proven to be the leading contributors to myopericarditis in the pediatric and adult populations. Despite the current comprehensive knowledge of myocardial injury in viral and post-viral myopericarditis, the cellular and molecular mechanisms of SARS-CoV-2-induced myopericarditis are poorly understood. This report presents a case of coronavirus (COVID-19) fulminant myopericarditis and acute respiratory distress syndrome (ARDS) in a middle-aged male patient: a 51-year-old man with a history of hypertension who arrived to the emergency department with a dry cough, fatigue, dyspnea, and a fever. A real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay confirmed a diagnosis of COVID-19 infection, resulting in the patient's admission to the airborne isolation unit for clinical observation. When his condition began to deteriorate, the patient was transferred to the cardiac care unit after electrocardiography detected cardiac injury, demonstrating diffuse ST-segment elevation. Laboratory evaluations revealed elevated troponin T and BNP, with an echocardiogram indicating global left ventricular hypokinesia and a reduced ejection fraction. The patient was treated with hydroxychloroquine, azithromycin, dobutamine, remdesivir, and ventilatory support. This specific case highlights the severity and complications that may arise as a direct result of COVID-19 infection.
心肌心包炎在患者一生中仍是一种突出的感染性炎症性疾病。此外,病毒病原体已被证明是儿童和成人人群中心肌心包炎的主要病因。尽管目前对病毒性和病毒后心肌心包炎中心肌损伤有全面的认识,但对严重急性呼吸综合征冠状病毒2(SARS-CoV-2)引起的心肌心包炎的细胞和分子机制了解甚少。本报告介绍了一名中年男性患者发生冠状病毒病(COVID-19)暴发性心肌心包炎和急性呼吸窘迫综合征(ARDS)的病例:一名51岁男性,有高血压病史,因干咳、乏力、呼吸困难和发热到急诊科就诊。实时逆转录聚合酶链反应(RT-PCR)检测确诊为COVID-19感染,该患者被收入空气传播隔离病房进行临床观察。当他的病情开始恶化时,心电图检测到心脏损伤(表现为弥漫性ST段抬高)后,该患者被转至心脏监护病房。实验室检查显示肌钙蛋白T和脑钠肽升高,超声心动图显示左心室整体运动减弱和射血分数降低。该患者接受了羟氯喹、阿奇霉素、多巴酚丁胺、瑞德西韦治疗及通气支持。这个特殊病例突出了COVID-19感染可能直接导致的严重性和并发症。