Successful Treatment of a COVID-19 Patient with Fulminant Myocarditis: A Case Report and Review of Literature

Abstract

Lung damage is the primary clinical concern when treating Coronavirus Disease 2019 (COVID-19) patients. However, not enough attention has been given to potential myocardial damage associated with COVID-19 infection. Here, we report a 65-year-old woman who diagnosed with COVID-19 and myocarditis based on 2019-nCoV nucleic acid test, electrocardiogram (ECG), and myocardial markers. The patient with fulminant myocarditis who presented with the following: (1) obvious symptoms of pulmonary infection without any cardiac-specific symptoms; (2) alleviation of pulmonary symptoms with worsening myocardial damage after treatment; and (3) sudden cardiac arrest caused by malignant arrhythmia. The patient was administered oral Ambroxol tablets, Arbidol Hydrochloride capsules, Lianhuaqingwen capsules (Traditional chinesemidicine), and Ibuprofen capsules, as well as intravenous Moxifloxacin, 20% human serum albumin, and Imipenem sildastatin sodium. On day 8 after hospitalization, the patient suddenly went into a cardiac arrest.After cardiopulmonary resuscitationand electric defibrillation, the patient's vital sign recovered and was immediately transferred to ICU for further treatment. The patient received high-dose methylprednisolone (500mg/d), immunoglobulin therapy (20g/d), ventilator-assisted ventilation, and extracorporeal membrane pulmonary oxygenation (ECMO).One month later, the patient was in stable condition and discharged home. This case study and the literature indicate that symptoms of myocardial injury caused by COVID-19 may be atypical and may develop prior to the onset of pulmonary symptoms. Therefore, active prevention and early adoption of various treatment measures, even in the absence of myocardial injury, may benefitCOVID-19 patients.