Myocarditis- A Life-Threatening Presentation of COVID-19 in a 4-Month Old Infant

Significant cardiac sequelae may be considered as one of the principal causes of death in COVID-19 individuals; however, very few publications are available that address these complications and their treatment strategies in the pediatric age group.

A 4-month-old male infant was admitted to the PICU with sudden tachycardia, tachypnea and low oxygen saturation after surgery. Laboratory tests and echocardiography revealed elevated troponin-I (Trop I) levels and myocardial dyskinesia with decreased left ventricular ejection fraction (LVEF= 50%) and pulmonary hypertension (30 mmHg) consistent with cardiac injury. In spite of a normal chest x-ray, Chest CT-Scan disclosed ground glass opacities in the periphery of the left lower lobe indicative of viral infection. The patient fulfilled the diagnostic criteria of the Chinese expert consensus statement for clinical myocarditis. Viral tests for COVID-19 obtained on the first day of admission were found positive a few days later. The patient successfully recovered clinically after receiving anti-failure therapy and IVIG. Trop I level reduced to 0.10 g/L and the LVEF eventually recovered to 68%.

COVID-19 patients may develop severe cardiac complications such as myocarditis and heart failure. Myocarditis in this patient can be treated without antiviral drugs and only needing supportive therapies.