- SARS-CoV-2-related acute myocarditis may present as a reverse Tako-Tsubo syndrome.
- Endomyocardial biopsy revealed diffuse T-lymphocytic inflammatory infiltrates with important interstitial oedema and limited foci of necrosis; no replacement fibrosis was detected, suggesting an acute inflammatory process. Molecular analysis showed absence of the SARS-CoV-2 genome within the myocardium.
This case report highlights an atypical presentation of acute myocarditis in a COVID-19 patient and provides the first direct evidence of myocardial inflammation. The 43-year-old Italian woman with no medical history presented to the emergency department (at San Raffaele Hospital in Milan, Italy) with chest pain and dyspnea; numerous investigations were performed, notably coronary computed tomography angiography, cardiac magnetic resonance and endomyocardial biopsy, and the final diagnosis was acute virus-negative lymphocytic myocarditis associated with SARS-CoV-2 respiratory infection. The patient was treated empirically with lopinavir/ritonavir 500 mg b.i.d. and hydroxychloroquine 200 mg b.i.d., and after showing progressive improvement, was finally discharged with without symptoms on day 13.
Sala S., Peretto G., Gramegna M., Palmisano A., Villatore A., Vignale D., De Cobelli F., Tresoldi M., Cappelletti A.M., Basso C., Godino C. and Esposito A. (April 8, 2020). Acute myocarditis presenting as a reverse Tako-Tsubo syndrome in a patient with SARS-CoV-2 respiratory infection. European Heart Journal. https://doi.org/10.1093/eurheartj/ehaa286