Özturan İbrahim Ulaş, Köse Beril, Özkan Buğra, Köse Ataman
Department of Emergency Medicine, Mersin Toros State Hospital, Mersin, Turkey.
Department of Cardiology, Faculty of Medicine, Mersin University, Mersin, Turkey.
Clin Exp Emerg Med. 2020 Dec;7(4):326-329. doi: 10.15441/ceem.20.109. Epub 2020 Dec 31.
A 25-year-old man presented to the emergency department with acute-onset chest pain and shortness of breath. A physical examination revealed coarse crackles in the both lower lungs. Consolidation and ground-glass opacities suggesting viral infection were detected in the right lower lobe on chest computed tomography. Laboratory findings revealed elevated troponin, leukocytosis, and lymphopenia. Electrocardiography revealed ST segment elevation with PR depression in leads I, aVL, V5, and V6, and ST depression and PR elevation in aVR. Echocardiography revealed diffuse cardiac hypokinesia and a decreased left ventricular ejection fraction. Suspecting coronavirus disease 2019 (COVID-19)-related myopericarditis, the patient was hospitalized. After one week of empirical antibiotics, antivirals, and supportive therapy, his condition improved. Antibody testing for COVID-19 was positive on hospitalization day 8. The presentation of myopericarditis can be vague and mislead physicians during the COVID-19 pandemic. Myopericarditis should be included as a differential diagnosis for patients with suspected COVID-19.
一名25岁男性因突发胸痛和呼吸急促被送往急诊科。体格检查发现双下肺有粗湿啰音。胸部计算机断层扫描显示右下叶有实变和磨玻璃样混浊,提示病毒感染。实验室检查结果显示肌钙蛋白升高、白细胞增多和淋巴细胞减少。心电图显示I、aVL、V5和V6导联ST段抬高伴PR段压低,aVR导联ST段压低和PR段抬高。超声心动图显示弥漫性心肌运动减弱和左心室射血分数降低。怀疑为2019冠状病毒病(COVID-19)相关的心肌心包炎,该患者被收治入院。经过一周的经验性抗生素、抗病毒药物和支持治疗后,他的病情有所改善。住院第8天,COVID-19抗体检测呈阳性。在COVID-19大流行期间,心肌心包炎的表现可能不明确,会误导医生。对于疑似COVID-19的患者,应将心肌心包炎纳入鉴别诊断。