COVID-19-related myocarditis in a 21-year-old female patient
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A 21-year-old female patient visited the hospital for febrile sensation, coughing, sputum, diarrhoea, and shortness of breath during the coronavirus disease 2019 (COVID-19) outbreak in Daegu, South Korea. Nasopharyngeal swab was positive for COVID-19. Troponin I level was 1.26 ng/mL and NT-proBNP was 1929 pg/mL. The chest radiograph revealed a multifocal consolidation on both lung fields and cardiomegaly.

Electrocardiography showed non-specific intraventricular conduction delay and multiple premature ventricular complexes. Echocardiography showed severe left ventricular (LV) systolic dysfunction. A chest computed tomography (CT) revealed a multifocal consolidation and ground-glass opacification in both lungs in the lower lobe and a peripheral dominant distribution. On the cardiac CT, the coronary arteries were normal, and the myocardium was hypertrophied due to oedema combined with a subendocardial perfusion defect on the lateral left ventricle.

Cardiac magnetic resonance imaging (MRI) revealed a diffuse high signal intensity (SI) in the LV myocardium on T2 short tau inversion recovery image (SI ratio of myocardium over skeletal muscle = 2.2), and myocardial wall thickening (LV mass index: 111.3 g/m2), which suggests myocardial wall oedema. On mapping sequence, native T1 (mid-septum, 1431 ms; lateral wall, 1453 ms) and extracellular volume (mid-septum, 29.7%; lateral wall, 61%) values were diffusely increased. Extensive transmural late gadolinium enhancement was noted. Myocarditis combined with COVID-19 was confirmed by multimodality imaging.