Mehrban Saghar, Omidvar Razieh, Jalali Somayeh Sadat, Pouraliakbar Hamidreza, Favaedi Maryam, Almasi Simin
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, 1995614331, Iran.
Department of Rheumatology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran.
Radiol Case Rep. 2023 Sep;18(9):3032-3036. doi: 10.1016/j.radcr.2023.05.071. Epub 2023 Jun 21.
Cardiovascular disorders are significantly associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Herein, we describe a case of myopericarditis and subsequent transient constrictive pericarditis after coronavirus disease 2019 (COVID-19). Three weeks following a mild SARS-CoV-2 illness, a 53-year-old woman was referred to the hospital with acute pleuritic chest pain, which was not attributable to any known cause and was only temporarily relieved. The pain persisted for the next few weeks until her second COVID-19 infection, which occurred 5 months after her first affliction. This time, Transthoracic echocardiography (TTE) revealed mild pericardial effusion, and cardiac magnetic resonance imaging (CMR) confirmed myopericarditis, leading to the administration of anti-inflammatory therapy for the patient. Despite a relative resolution of symptoms, her second CMR performed 8 months later revealed active perimyocarditis with transient constrictive pericarditis (CP). Additionally, fluorescent antinuclear antibody (FANA) and antimitochondrial Ab M2 (AMA) were tested positive for the first time. Thereafter, the patient was started on concurrent anti-inflammatory and immunosuppressant therapies, which were effective after 3 months. The transient CP was resolved, and there was no sign of active pericarditis on her last echocardiography. Acute pericarditis and its subsequent constrictive pericarditis are infrequent adverse outcomes of COVID-19. The unique feature of this case is the uncertainty regarding the underlying reason for cardiac complications, whether it is the first presentation of systemic lupus erythematosus (SLE) or viral-induced myopericarditis followed by a consequent transient CP.
心血管疾病与严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染显著相关。在此，我们描述一例2019冠状病毒病（COVID-19）后发生的心肌炎和随后的短暂缩窄性心包炎病例。在轻度SARS-CoV-2感染三周后，一名53岁女性因急性胸膜炎性胸痛被转诊至医院，该胸痛无任何已知病因，仅暂时缓解。疼痛在接下来的几周持续存在，直到她在首次患病5个月后第二次感染COVID-19。此次，经胸超声心动图（TTE）显示轻度心包积液，心脏磁共振成像（CMR）确诊为心肌炎，遂对患者进行抗炎治疗。尽管症状相对缓解，但8个月后她的第二次CMR显示活动性心肌心包炎伴短暂缩窄性心包炎（CP）。此外，荧光抗核抗体（FANA）和抗线粒体抗体M2（AMA）首次检测呈阳性。此后，患者开始同时接受抗炎和免疫抑制治疗，3个月后有效。短暂性CP得到缓解，她最后一次超声心动图检查未显示活动性心包炎迹象。急性心包炎及其随后的缩窄性心包炎是COVID-19罕见的不良后果。该病例的独特之处在于心脏并发症的潜在原因尚不确定，是系统性红斑狼疮（SLE）的首次表现还是病毒感染引起的心肌炎继而导致短暂性CP。
