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Case Reports
. 2022 Feb 18;10(2):e0630.
doi: 10.1097/CCE.0000000000000630. eCollection 2022 Feb.

Clinical and Histopathologic Features of Myocarditis in Multisystem Inflammatory Syndrome (Adult)-Associated COVID-19

Saud Aldeghaither  1   2 , Rayan Qutob  1   3 , Nawaporn Assanangkornchai  1   4 , Badia Issa-Chergui  5 , May Tam  6 , Rita Larotondo  7 , Gordan Samoukovic  1
Affiliations
Case Reports

Clinical and Histopathologic Features of Myocarditis in Multisystem Inflammatory Syndrome (Adult)-Associated COVID-19

Saud Aldeghaither et al. Crit Care Explor. .

Abstract

Background: Multisystem inflammatory syndrome (MIS) associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is a life-threatening condition first described in children (MIS-C). It is characterized by a hyperinflammatory state that involves the cardiovascular, gastrointestinal, dermatologic, and neurologic systems without severe respiratory system involvement. Myocarditis is one of the cardiovascular presentations of MIS that might be complicated with cardiogenic shock. There are few case reports describing SARS-CoV-2-related MIS in adults (MIS-A).

Case summary: Three cases of healthy young adults diagnosed with severe acute respiratory syndrome-CoV-2 related (MIS-A). The main presentation was cardiogenic shock secondary to histologically proven myocarditis, which resolved rapidly after initiation of medical therapy including anti-inflammatory and immunosuppressive drugs. All the cases, however, required mechanical circulatory support (MCS) as a bridge to recovery.

Conclusions: It appears reasonable to treat the patient with fulminant myocarditis in SARS-CoV-2-associated MIS-A with high-dose corticosteroid "pulse" therapy in order to suppress the inflammatory response and MCS to correct initial metabolic derangement and reestablish/maintain vital organ perfusion. Addition of IV immunoglobulin and other immunomodulators should be assessed in a case-by-case basis especially considering the associated cost resource allocation.

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Conflict of interest statement

The authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Illustration of the main events from admission until discharge including laboratory, echocardiography finding, and administered therapeutics. A, Case 1. B, Case 2. C, Case 3. CP = cardiac power, CRP = C-reactive protein, HS = high sensitivity, IVIG = IV immunoglobulin, LVEF = left ventricular ejection fraction, RVAD = right ventricular assist device, VA-ECMO = venoarterial extracorporeal membrane oxygenation.
Figure 2.
Figure 2.
High-power field showing the infiltrate consisting predominantly of mononuclear cells (few lymphocytes and histiocytes with many eosinophils).
Figure 3.
Figure 3.
High-power view showing mixed inflammatory infiltrate with lymphocytes, histiocytes neutrophils, and eosinophils.
Figure 4.
Figure 4.
High-power view showing mild lymph-histiocytic interstitial myocardial infiltrate with occasional neutrophil.
See this image and copyright information in PMC

References

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