A 34-year-old woman was admitted with complaint of losing consciousness and she had also been suffering from fever and headache for six consecutive days. Vital signs were as follows: body temperature = 36.7°C, systolic blood pressure = 80/60 mmHg, heart rate = 114/min, and O2 saturation = 82% without oxygenation. Also, the GCS score equaled 8. The ECG monitoring revealed ventricular tachycardia (Figure ); so, the direct current (DC) shock was administered and the patient was intubated. Echocardiography showed normal LV and RV size, moderate tricuspid and mitral regurgitation, systolic pulmonary artery pressure of 30 mmHg, and LVEF of 30%. The chest CT scan illustrated bilateral GGO and basal consolidations (Figure ) as well as the patient had a positive nasal and oropharyngeal PCR test for COVID-19. The patient received broad-spectrum antibiotics (meropenem [500 mg q8 h for 5 days] and doxycycline [200 mg/day]), high-dose corticosteroid (methylprednisolone 1 g/day), and remdesivir for COVID-19. The patient was discharged after 3 weeks with LVEF of 40%–45% and normal cardiac biomarkers. Follow-up of the patient for 3 months showed an LVEF of 45%–50%.
A 15-year-old girl (with no underlying disease) was admitted with mild dyspnea, abdominal pain, nausea, and fever that had occurred for 2 days before admission. At the time of admission, vital signs were as follows: body temperature = 39.8°C, systolic blood pressure = 90/50 mmHg, heart rate = 120/min, and O2 saturation = 95% without oxygenation. Cold limbs and thready pulse were obvious through physical examination. Moreover, the ECG revealed sinus tachycardia and inverted T wave in lateral limb and precordial leads. Simultaneously, an enlarged liver (146 mm) and elevated levels of liver enzymes (alanine aminotransferase [ALT] = 176 U/L, aspartate aminotransferase [AST] = 120 U/L, alkaline phosphatase [ALP] = 170 U/L, albumin = 4.5 g/dl, total bilirubin = 1 mg/dl, and direct bilirubin = 0.3 mg/dl) were observed that were suggestive of acute hepatitis. The TTE indicated severe ventricular (RV and LV) enlargement and dysfunction (LVEF = 5%–10%), moderate mitral regurgitation, PAP = 35 mmHg, and mild pericardial effusion. The patient had a positive nasal and oropharyngeal PCR test for COVID-19, and the lung CT scan disclosed GGO as well as peripheral consolidations (Figure ). The patient was treated with broad-spectrum antibiotics (meropenem [500 mg q8 h for 5 days] and doxycycline [200 mg/day]), corticosteroids (methylprednisolone 1 mg/kg/day), and remdesivir. Ten days after admission, the patient was discharged from the hospital in a stable condition with normalization of white blood cell (WBC) count and liver enzymes, and the TTE exhibited no change compared to the first examination. However, an LVEF of 20% and a dysfunctional and enlarged RV were observed by follow-up of the patient for 3 months. It is worth mentioning that the patient suffered from dyspnea during ordinary physical activities (functional class II).