key: cord-0969315-xge8ib6r
authors: Edwards, Jonathan J.; Harris, Matthew A.; Toib, Amir; Burstein, Danielle S.; Rossano, Joseph W.
title: Asymmetric septal edema masking as hypertrophy in an infant with COVID-19 myocarditis
date: 2021-11-22
journal: Prog Pediatr Cardiol
DOI: 10.1016/j.ppedcard.2021.101464
sha: 7e05c7d50ee29295c7a1f9e2dfcc0634d2f6d75b
doc_id: 969315
cord_uid: xge8ib6r

Cardiac disease in pediatric patients due to coronavirus SARS-CoV-2 disease (COVID-19) include myocarditis and multisystem inflammatory syndrome, both of which can present with a broad range in severity. Here we describe an infant with COVID-19 causing fulminant myocarditis with inotrope-resistant acute heart failure requiring extracorporeal membrane oxygenation. The patient demonstrated an atypical finding of localized septal thickening suggestive of hypertrophic cardiomyopathy, but the diagnosis of myocarditis was confirmed by cardiac MRI. Serial echocardiography illustrated complete resolution of septal hypertrophy and normalized cardiac function. The current report highlights the potential severity of COVID-19 associated myocarditis, the potential for recovery, and the utility of cardiac MRI in confirming the mechanism.

Myocarditis can present with a wide range of severity, from a minimally elevated serum troponin level to fulminant presentations with severe myocardial dysfunction. In addition to myocarditis, COVID-19 can also cause myocardial dysfunction as part of a multisystem inflammatory syndrome (MIS-C). Myocarditis is largely diagnosed via magnetic resonance imaging (MRI), using the Lake Louise Criteria. Here we describe an infant presenting with fulminant myocarditis due to COVID-19 and how use of MRI aided in differentiation of severe septal thickening due to edema as opposed to a true cardiomyopathy.

A 10-month-old male with a past medical history of Trisomy 18p, monosomy of 8p, and a small conoventricular ventricular septal defect presented with a 4-day history of upper respiratory symptoms and fever that progressed to acute cardiopulmonary failure.

He was directly admitted from the emergency department to the Intensive Care Unit (ICU) on noninvasive positive pressure respiratory support. Limited cardiac evaluation on presentation revealed a low brain natriuretic peptide (BNP, 10 pg/mL Figure 1D) . He was discharged to home on illness day 47 on no cardiac medications. At follow up, 75 days after onset of illness, there was complete resolution of septal wall thickening with preserved systolic function ( Figure 1D ).

To our knowledge, this is the first report of a patient with severe COVID-19 myocarditis and associated myocardial edema masking as asymmetric septal wall thickening. In J o u r n a l P r e -p r o o f

Multisystem inflammatory syndrome in children

Cardiovascular Magnetic Resonance in Nonischemic Myocardial Inflammation: Expert Recommendations

Transient left ventricular wall thickening in a 14-year-old girl with influenza A myocarditis

COVID-19 Trends Among School-Aged Children -United States

This work was supported by the National Institutes of Health [5T32HL007915, 2021].

The authors have no potential conflicts of interests to disclose.

This study was approved by the Institutional Review Board of the Children's Hospital of Philadelphia by waiver of consent for a single case report. 

☒ The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.☐The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:J o u r n a l P r e -p r o o f