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

Journal

Critical care explorations
ISSN: 2639-8028
Titre abrégé: Crit Care Explor
Pays: United States
ID NLM: 101746347

Informations de publication

Date de publication:
Feb 2022
Historique:
entrez: 25 2 2022
pubmed: 26 2 2022
medline: 26 2 2022
Statut: epublish

Résumé

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). 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. 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.

Sections du résumé

BACKGROUND 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 METHODS
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 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.

Identifiants

DOI: 10.1097/CCE.0000000000000630 PMID: 35211680 PMC: PMC8860337
pubmed: 35211680
doi: 10.1097/CCE.0000000000000630
pmc: PMC8860337
doi:

Types de publication

Case Reports

Langues

eng

Pagination

e0630

Informations de copyright

Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.

Déclaration de conflit d'intérêts

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

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Auteurs

Saud Aldeghaither (S)

Department of Critical Care Medicine, McGill University, Montreal, QC, Canada.
Department of Critical Care Medicine, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia.

Rayan Qutob (R)

Department of Critical Care Medicine, McGill University, Montreal, QC, Canada.
Faculty of Medicine, Department of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia.

Nawaporn Assanangkornchai (N)

Department of Critical Care Medicine, McGill University, Montreal, QC, Canada.
Faculty of Medicine, Department of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.

Badia Issa-Chergui (B)

Department of Pathology, McGill University, Montreal, Quebec, QC, Canada.

May Tam (M)

Perfusion Department, McGill University, Montreal, QC, Canada.

Rita Larotondo (R)

Nursing Department, McGill University, Montreal, QC, Canada.

Gordan Samoukovic (G)

Department of Critical Care Medicine, McGill University, Montreal, QC, Canada.

Classifications MeSH