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Case Reports
. 2023 Jun 22:2023:7646962.
doi: 10.1155/2023/7646962. eCollection 2023.

Acute Lymphocytic Myocarditis in a Young Male Post-COVID-19

Mintje Bohné  1 , Sebastian Bohnen  1 , Stephan Willems  1 , Karin Klingel  2 , Dietmar Kivelitz  3 , Edda Bahlmann  1
Affiliations
Case Reports

Acute Lymphocytic Myocarditis in a Young Male Post-COVID-19

Mintje Bohné et al. Case Rep Cardiol. .

Abstract

Background: Lymphocytic myocarditis is a rare form of myocarditis, associated with a high mortality rate due to a high risk of sudden cardiac death. Lymphocytic myocarditis might present as a relevant extrapulmonary manifestation after coronavirus disease 2019 (COVID-19) infection. Case presentation. We report a case of a 26-year-old male with lymphocytic myocarditis, presenting with a 1-month history of increasing fatigue, palpitations, and shortness of breath. Eight weeks before, he was tested positive for SARS-CoV-2. He had received 2-dose schedule of the COVID-19 mRNA vaccine Comirnaty® (BioNTech/Pfizer) 6 months prior to his admission. Diagnostic work-up by echocardiography and cardiac magnetic resonance (CMR) imaging demonstrated a severely reduced left ventricular function and a strong midmyocardial late gadolinium enhancement (LGE). Histology and immunohistology of the endomyocardial biopsies revealed an acute lymphocytic myocarditis. Immunosuppressive therapy with a steroid taper in combination with azathioprine 300 mg/day was initiated. The patient was equipped with a LifeVest®. On day 17, a non-sustained ventricular tachycardia was documented. Follow-up CMR imaging after 3 months showed a slightly improved systolic left ventricular function, and a strong LGE was still detectable.

Conclusions: The case highlights the significance of recognizing lymphocytic myocarditis correlated to COVID-19. It is important to be vigilant also of a later presentation of cardiomyopathy in patients diagnosed with COVID-19 due to high mortality without immediate support.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Electrocardiogram demonstrating atrial tachycardia with 127 beats per minute and a right bundle branch block configuration.
Figure 2
Figure 2
Transthoracic echocardiography showing four chamber cardiac view.
Figure 3
Figure 3
CMR imaging study showing severe LV dysfunction and signs of acute myocarditis. (a and c) Three-chamber views, (b and d) short axis views. (a and b) LGE images with severe subepicardial to transmural LGE inferolateral and anterolateral. (c and d) Native T1-maps with focal increased native T1 values in LGE positive regions.
Figure 4
Figure 4
Histopathological images. (a) Histological findings in the endomyocardial biopsy showing active lymphocytic myocarditis with necrosis and areas of organization (Giemsa), (b) CD3 and T-cells, and (c) CD 68 and macrophages.
Figure 5
Figure 5
Electrocardiogram demonstrating non-sustained ventricular tachycardia and frequent premature ventricular complexes.
See this image and copyright information in PMC

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