Case Study - An Interesting Case of COVID-19 Induced Fulminant Myocarditis

A young patient, aged 31 years old, initially presented to other facility with complaints of mild fever, throat pain, and generalized myalgia. His COVID19 test came out positive, confirming that the patient was suffering from COVID19. Since the patient’s chest CT scan was normal and without any consolidations characteristic of COVID19, he was prescribed antibiotics and an antipyretic, instructed to follow strict home isolation, and then sent home.

The same patient reported to the Emergency Department once again. This time, his symptoms were severe. He was experiencing extreme shortness of breath, an exaggerated cough, and above all, extreme fatigue and exhaustion which was evident from his overall general appearance. The patient appeared to be severely ill, and had both tachycardia and tachypnea. His oxygen saturation levels were 85%, which is low, and he required oxygen support immediately.

Furthermore, his neck veins were severely congested and he had a raised JVP. He had distant heart sounds, and his chest auscultation revealed bibasilar crackles. The left lobe of the liver was palpable. There was, however, no indication of any ascites, or fluid retention anywhere else in the body. His ECG reports revealed that he was suffering from sinus tachycardia. There was evident ST-segment elevation on the ECG, which was persistent with the diagnosis of myocardial ischemia. The chest x-ray, which was initially normal, showed cardiomegaly in the preceding x- ray. The findings were consistent with the conclusion that the heart was definitely part of the equation.

It was later diagnosed that this was a classic presentation of acute fulminant myocarditis which occurs secondarily due to COVID19. The diagnosis took time, but fortunately, the patient had presented to the Emergency in time and this led to him getting admitted, evaluated, and treated within the period before any other complication took place.

Although patients with pre-existing or a predisposition to developing heart conditions are more inclined towards such outcomes, it can affect almost anyone owing to the complicated nature of the virus itself.