Cardiac endotheliitis and MIS during COVID-19 recovery: Firs
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Autopsy findings in a young COVID-19 patient who seemed to be recovering, then rapidly deteriorated and died, showed vasculitis of the small vessels of the heart, apparently reflecting a variant of multisystem inflammatory syndrome (MIS).

The report, published in Annals of Internal Medicine, suggests that close monitoring is still needed during the COVID-19 recovery phase.

The 31-year-old Black woman had survived to discharge after hospitalization for COVID-19. However, she returned 12 days later and died during evaluation for another hospital admission when she developed hemodynamic instability and ventricular fibrillation. She could not be resuscitated.

Of note, the coronary arteries were spared, and neutrophils were identified along with CD4+>CD8+ lymphocytes. The appearance was not that of a lymphocytic or eosinophilic myocarditis, and cardiac myocytes did not seem to be the target of the inflammatory process.

The autopsy was also significant for the presence of new pulmonary thrombi in a background of otherwise reparative changes in the lungs. These thrombi indicate a potential for hypercoagulability affecting the pulmonary vasculature beyond the initial course of COVID-19, as well as the need for continued monitoring of laboratory markers and possible anticoagulation," researchers said.

During hospitalization for COVID-19, the woman in the present autopsy case had been treated with azithromycin and hydroxychloroquine. She returned 12 days after discharge with sudden fever, throbbing left-sided neck pain, nausea, and vomiting. By then, she was no longer positive for SARS-CoV-2.

"A high degree of vigilance for cardiac symptoms is required in the setting of acute COVID-19 infection," researchers said.

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