COVID-19-related myocarditis in a 21-year-old female patient

A 21-year-old female patient visited our hospital for febrile sensation, coughing, sputum, diarrhoea, and shortness of breath during the coronavirus disease 2019 (COVID-19) outbreak in Daegu, South Korea. Nasopharyngeal swab was positive for COVID-19. Troponin I level was 1.26 ng/mL (<0.3 ng/mL) and NT-proBNP was 1929 pg/mL (<125 pg/mL). The chest radiograph revealed a multifocal consolidation on both lung fields and cardiomegaly (Panel A). Electrocardiography showed non-specific intraventricular conduction delay and multiple premature ventricular complexes (Panel B). Echocardiography showed severe left ventricular (LV) systolic dysfunction (Supplementary material online, Videos S1–S3). A chest computed tomography (CT) revealed a multifocal consolidation and ground-glass opacification in both lungs in the lower lobe and a peripheral dominant distribution (Panel C). On the cardiac CT, the coronary arteries were normal (Panels D–G), and the myocardium was hypertrophied due to oedema combined with a subendocardial perfusion defect on the lateral left ventricle (Panel N). Cardiac magnetic resonance imaging (MRI) revealed a diffuse high signal intensity (SI) in the LV myocardium on T2 short tau inversion recovery image (Panels H–J; SI ratio of myocardium over skeletal muscle = 2.2), and myocardial wall thickening (LV mass index: 111.3 g/m²), which suggests myocardial wall oedema. On mapping sequence, native T1 (Figure 1K–M; mid-septum, 1431 ms; lateral wall, 1453 ms, reference value ∼1150 ms) and extracellular volume (Panels P–R; mid-septum, 29.7%; lateral wall, 61%; reference value ∼25%) values were diffusely increased (Panel O). Extensive transmural late gadolinium enhancement was noted (Panels S–U). Myocarditis combined with COVID-19 was confirmed by multimodality imaging.

Supplementary material is available at European Heart Journal online.