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Original article

Vol. 152 No. 2930 (2022)

Difficulties in diagnosis of SARS-CoV-2 myocarditis in an adolescent

  • Alessia Callegari
  • Karin Klingel
  • Janet Kelly-Geyer
  • Christoph Berger
  • Julia Geiger
  • Walter Knirsch
DOI
https://doi.org/10.4414/SMW.2022.w30214
Cite this as:
Swiss Med Wkly. 2022;152:w30214
Published
28.07.2022

Abstract

OBJECTIVES: We present an adolescent with cardiogenic shock due to ventricular tachycardia 2 weeks after SARS-CoV-2 infection. Acute myocarditis or myocardial dysfunction is associated with SARS-CoV-2 infection, but diagnosis may be difficult, even including endomyocardial biopsy.

CASE REPORT: A 15-year-old  healthy adolescent was admitted to our hospital 2 weeks after SARS-CoV-2 infection with cardiogenic shock due to ventricular tachycardia. After cardioversion, antiarrhythmic treatment, ventilation, and inotropic support, the severely reduced myocardial function recovered completely within 2 weeks. Cardiac magnetic resonance imaging and cardiac catheterisation including right ventricular endomyocardial biopsy revealed an increased number of CD68+ macrophages in the myocardium, but nested (RT-) polymerase chain reaction (PCR) investigations revealed no viral or bacterial DNA/RNA.

DISCUSSION: SARS-CoV-2 infection may be associated with myocarditis leading to life-threatening arrhythmia and severe myocardial systolic and diastolic dysfunction, which may be short lasting and completely recover. Although former SARS-Cov-2 infection might suggest SARS-CoV-2-associated myocarditis, definite histological diagnosis including nested PCR investigations remains difficult.

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