key: cord-1021144-h8pyxym3 authors: Coll, Maxwell D.; Yanamandala, Mounica; Ferro, Enrico G.; Nutt, Cameron T.; Wei, Eric Q.; Wang, Christine J.; Mehra, Mandeep R. title: Early Immunosuppression and Rapid Recovery of Cardiogenic Shock in Multisystem Inflammatory Syndrome From Convalescent COVID-19 date: 2021-09-15 journal: JACC Case Rep DOI: 10.1016/j.jaccas.2021.06.045 sha: dabbeeaed94e9325df55e7be989fba33db03b045 doc_id: 1021144 cord_uid: h8pyxym3 A previously healthy 39-year-old man presented in cardiogenic shock with evidence of multisystem inflammatory syndrome of adults 2 months after a mild case of coronavirus disease 2019. He was treated with intravenous immunoglobulin and pulse-dose corticosteroids with rapid resolution of his symptoms and normalization of biventricular function. (Level of Difficulty: Intermediate.) Recognize MIS-A as a rare but important complication of convalescent COVID-19. Identify the importance of rapid initiation of immunosuppression in fulminant inflammatory myocardial processes to prevent complications. Consider the pathophysiologic implications of response to IVIG in patients with MIS-A. x-ray showed moderate pulmonary edema. He was admitted to the cardiac intensive care unit (CCU) for further evaluation. He had been diagnosed with coronavirus disease-2019 (COVID-19) by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) nasopharyngeal swab real-time polymerase chain reaction (RT-PCR) 8 weeks prior. He had not required hospitalization, received no antiviral or immunomodulatory therapies, and recovered to his usual state of health. The differential for this patient's biventricular failure resulting in cardiogenic shock included nonischemic etiologies such as viral myopericarditis, stress cardiomyopathy, giant cell or eosinophilic myocarditis, a hyperinflammatory syndrome, or possibly acute coronary syndrome. Endomyocardial biopsy was deferred. A systemic hyperinflammatory process was believed to be the most likely etiology of his biventricular and prevention of lasting end-organ damage (9) . As in our case, pulse-dose corticosteroids and IVIG were needed to determine optimal treatment strategies. Cardiovascular considerations for patients, health care workers, and health systems during the COVID-19 Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China Endothelial cell infection and endotheliitis in COVID-19 Association of cardiac infection with SARS-CoV-2 in confirmed COVID-19 autopsy cases Pathological evidence for SARS-CoV-2 as a cause of myocarditis: JACC review topic of the week Case series of multisystem inflammatory syndrome in adults associated with SARS-CoV-2 infection -United Kingdom and United States The immunology of multisystem inflammatory syndrome in children with COVID-19 The potential danger of suboptimal antibody responses in COVID-19 Cardiogenic shock and hyperinflammatory syndrome in young males with COVID-19