23-year-old male. No medical history
Not vaccinated for Sars-Cov2;
Recent Sars-Cov2 infection (negative antigenic swab on 03/01/22);
Pharyngodynia treated with ibuprofen + ciprofloxacin and amoxicillin ac clavulanic acid(suspended for purpuric lesions on hands)
After 5 days from onset of symptoms, access to PS for loss of consciousness.
Laboratory: ph 7.4; Lat 3.4
EKG: sinus tachycardia HR 126 bpm
Non-dilated left ventricle, marked reduction in FE (15%) spontaneous echocontrast in ventricular cavity
chest TC: hypodense tissue in anterior mediastinum; adenopathy in peribronchial site, distended gallbladder
transfer to Vanvitelli Cardiac ICU Amine support with augmented DBT for hypotension and tachycardia
LAB: Tni 2193; Nt proBNP 27796; PCR 26; PCT 4; crea 1,4, Lat 1
CATH DX + EMB
after 24 hours EBM: …Mixed cellularity endomyocarditis, predominantly lymphocytic, presence of eosinophils…
enrollment in the MYTHS study: placebo group (saline solution)
after 10 day MRI:Normal biventricular systolic function. Tissue characterization images consistent with the presence of limited area of active myocardial damage and with nonischemic pattern involving the basal segment of the infero-lateral wall of the left ventricle.
the case has been a source of considerable discussion to establish the etiology of myocarditis. Although with numerous doubts, after careful evaluation of the histologic picture, the case falls under possible MIS-A (MULTISYSTEM INFLAMMATORY SYNDROME in adult) Cardiac manifestations of MIS-A include myocarditis, pericarditis, and arrhythmias, which can rapidly lead to cardiogenic shock.