An 11-year-old girl lost consciousness on the seventh day after the onset of COVID-19, and was admitted to the hospital. Her ventricular tachycardia was not well controlled. Her serum troponin I level was 14.2 ng/mL (normal range <0.04 ng/mL). Veno-arterial extracorporeal membrane oxygenation was established, and remdesivir, steroid pulse, intravenous immunoglobulin, and other treatments were administered. Her left ventricular ejection fraction (LVEF) was decreased to 15.1% on her transthoracic echocardiography (TTE) on the second day after the admission. After those treatments, she recovered. On the 10th day after the extubation, magnetic resonance imaging (MRI) was performed (Ingenia 3.0T CX, Philips Healthcare). The native T1 and T2 values of the LV myocardium (LVM) were elevated (Figure A,B) to 1,398.9 ms (Figure C) and 52.8 ms, respectively (facility pediatric reference values of native T1 and T2 values were 1,236.5 ms and 40.6 ms). Therefore, she was diagnosed with COVID-19 myocarditis.1
Almost 3 months after the onset of COVID-19, LVEF was 60.2% on TTE. MRI was performed 6 months after the first MRI, and no late gadolinium enhancement was observed (Figure D) as in the subacute phase. The native T1 and T2 values of LVM had almost normalized to 1,256.1 ms and 43.5 ms (Figure E,F).
Regarding our literature review, this is the first report of MRI follow-up of COVID-19 fulminant myocarditis in a child.
Disclosure
Y.K. is a member of Circulation Journal’s Editorial Team.
