Department of Cardiovascular Medicine, St. Mary's Hospital, Kurume, Japan.
Department of Pathology, National Cerebral and Cardiovascular Center, Suita, Japan.
ESC Heart Fail. 2023 Apr;10(2):1461-1466. doi: 10.1002/ehf2.14295. Epub 2023 Jan 24.
Coronavirus disease 2019 (COVID-19) is often accompanied by pneumonia and can be fatal. We report a case of COVID-19-associated myocardial injury mimicking fulminant myocarditis. Endomyocardial biopsy revealed numerous von Willebrand factor-rich microthrombi with small myocardial necrotic areas, complement deposits in small vessels/microthrombi, and macrophage-predominant interstitial infiltration. These findings, distinct from those of typical lymphocytic myocarditis, show diffuse endothelial injury, complement activation, and activated macrophages as characteristic features of COVID-19-associated pathogenesis. Dysregulated serum cytokine profiles predicting severe/critical COVID-19-associated myocardial injury were also determined. This case emphasizes the occurrence of fatal cardiac manifestation with microthrombotic injury in the early stage of COVID-19.
2019 年冠状病毒病（COVID-19）常伴有肺炎，可致命。我们报告了一例 COVID-19 相关心肌损伤，类似于暴发性心肌炎。心肌内膜活检显示大量富含血管性血友病因子的微血栓和小面积心肌坏死区、小血管/微血栓中有补体沉积以及以巨噬细胞为主的间质浸润。这些发现与典型的淋巴细胞性心肌炎不同，表现为弥漫性内皮损伤、补体激活和活化的巨噬细胞，这是 COVID-19 相关发病机制的特征。还确定了预测严重/危重症 COVID-19 相关心肌损伤的失调血清细胞因子谱。本病例强调了 COVID-19 早期发生致命性心脏表现和微血栓损伤的情况。
