Author contributions: Matteo Pernigo and Marco Triggiani drafted the
manuscript; Emanuele Gavazzi, Simona Fisogni, Ester Costantino and Gian
Franco Pasini took part to clinical management of the case and data
collection; Ilaria Papa, Alberto Vaccari, Simona Fisogni and Emanuele
Gavazzi revised the manuscript.
REFERENCES
[1] Zhou F, Yu T, Du R,
Fan
G, Liu
Y, Liu
Z, et al. Clinical Course and Risk Factors for Mortality of Adult
Inpatients With COVID-19 in Wuhan, China: A Retrospective Cohort Study.
Lancet 2020; 395:1054-1062.
doi:
10.1016/S0140-6736(20)30566-3
[2] Xiong T-Y, Redwood S, Prendergast B, Chen M. Coronaviruses and
the cardiovascular system: acute and long-term implications. Eur Heart
J.2020; 41:1798-1800. doi: 10.1093/eurheartj/ehaa231.
[3] Li J-W, Han T-W, Woodward M,
Anderson
CS, Zhou
H, Chen
Y-D, et al. The impact of 2019 novel coronavirus on heart injury: A
systemic review and Meta-analysis. Prog Cardiovasc Dis. 2020 Apr 16;
S0033-0620(20)30080-3. doi: 10.1016/j.pcad.2020.04.008.
[4] Inciardi RM, Lupi L, Zaccone G, Italia L, Raffo M, Tomasoni D,
et al. Cardiac Involvement in a Patient With Coronavirus Disease 2019
(COVID-19). JAMA Cardiol. 2020; 5:1-6. doi:10.1001/jamacardio.2020.1096.
[5] Sala S, Peretto G, Gramegna M, Palmisano A, Villatore A, Vignale
D, et al. Acute myocarditis presenting as a reverse Tako-Tsubo syndrome
in a patient with SARS-CoV-2 respiratory infection. Eur Heart J. 2020
14; 41:1861-1862. doi: 10.1093/eurheartj/ehaa286.
[6]
Kim
IC, Kim
JY, Kim
HA, Han
S. COVID-19-related myocarditis in a 21-year-old female patient. Eur
Heart. 2020 14; 41:1859. doi: 10.1093/eurheartj/ehaa288.
[7] Cheng Y, Luo R, Wang K, et al. Kidney disease is associated with
in-hospital death of patients with COVID-19. Kidney Int 2020; 97:
829–38. doi: 10.1016/j.kint.2020.03.005.
[8] Ronco C, Reis T, Husain-Syed F. Management of acute kidney
injury in patients with COVID-19. Lancet Respir Med.
2020;S2213-2600(20)30229-0. doi: 10.1016/S2213-2600(20)30229-0.
FIGURE CAPTIONS
Figure 1: A. Electrocardiogram on admission. Sinus tachycardia
with left axis deviation, slight diffuse ST depression more prominent in
inferior-lateral lead.
B. Chest X-ray. Interstitial edema limited to left superior and lateral
regions, and no pleural effusion.
C. Image from high resolution computed tomography scan of the lungs.
Ground glass-like hyper density opacities in the peripheral portions of
inferior lobes bilaterally (arrows)
Figure 2: Echocardiogram performed on day
10th
a: Parasternal long-axis view, showing moderate concentric LV
hypertrophy with echo-bright appearance of myocardium. LV: left
ventricle; S: septum; LA: left atrium.
b-e: 2D-speckle tracking longitudinal strain evaluation; b: bull’s eye
with global results. Global longitudinal strain: -12% (18 segments).
Diffuse hypokinesia is evidenced, more pronounced in basal anterior and
septal segments (arrows), and relative apical sparing. c, d, e:
longitudinal strain evaluated in apical 4-chamber, 2-chamber, and
3-chamber views respectively, with strain curves for each segment.
Figure 3: Cardiac magnetic resonance imaging. Short tau
inversion recovery (STIR) sequences in 2-chamber (A) and short-axis view
(B) showed mild myocardial signal hyperintensity in left ventricle
anterior wall and anterior septum in medium and apical segments
(arrows), consistent with interstitial edema, confirmed and best
depicted in corresponding T2-Mapping sequences (C and D, arrows).Phase
sensitive inversion recovery (PSIR) sequences in short-axis (E) and
4-chamber view (F) showed diffuse intramural late gadolinium
enhancement.
Figure 4: Renal biopsy specimens, PAS (Periodic Acid Schiff)
stain. A: Capsular thickening and wrinkling of glomerular basement
membrane (arrow). Circumferential arteriolar hyaline sclerosis
(asterisk). B: Diffuse acute tubular injury with brush border loss,
tubular dilatation, epithelial thinning or swollen, focal vacuolization
(red arrows); partial desquamation of tubular epithelial cells (star);
focal regeneration features (prominent nucleoli and mitosis – yellow
arrows); modest interstitial chronic inflammation with minimal
tubulitis.
Supplementary files, Figure 1: image from cranial CT scan.
Several ischemic lacunar foci of the basal ganglia bilaterally (arrows),
and white matter hypodensity are visible.
Supplementary files, Figure 2: Coronary angiography. Upper
panels: left coronary artery. A 50% stenosis of mid left anterior
descending (LAD) artery and a 50% stenosis of the first marginal branch
of left circumflex (LCX) artery are visible. The lesions resulted non
emodynamically significant (as documented by iFR – not showed). Lower
panels: right coronary artery (RCA), no significant stenosis in the main
vessel – posterior descending artey (PDA). Significant stenosis of a
small posterior-lateral branch (PL).