A 16-year-old boy was admitted with fever, diarrhea, and dry cough that had occurred for 1 week before admission. The first evaluation of the patient at the time of admission was as follows: low blood pressure (80/60 mmHg), non-palpable pulse, and cyanosis, oxygen saturation was 85% without oxygenation, and the body temperature was 38°C. The ECG showed normal sinus rhythm with diffuse anterior ST-segment elevations in precordial leads (Figure ). Rapid improvement of the ECG abnormality resulted from carrying out vasopressors and intubation. Echocardiography represented left ventricular wall thickness, LVEF of 20%–25% with generalized hypokinesis, normal RV size (and function), and dilated inferior vena cava. Moreover, valvular structure and function were normal. The patient had a positive nasal and oropharyngeal PCR test for COVID-19, and the lung CT scan disclosed GGO (Figure ).\nThe patient received IVIG (1 g/kg), broad-spectrum antibiotics (meropenem [500 mg] and doxycycline [200 mg/day]), high-dose corticosteroid (methylprednisolone 1 g/day), and remdesivir for COVID-19. Nonetheless, the patient died the next day after admission due to sudden bradycardia, hypotension, and cardiac arrest.
A 32-year-old man was admitted with syncope after an episode of chest pain accompanied by fever and myalgia that had occurred for 4 days before admission. At the time of admission, the GCS score equaled 13, and he was confused. Also, he complained about dyspnea and dry cough. Vital signs were as follows: body temperature = 36.8°C, systolic blood pressure = 85/60 mmHg, heart rate = 120/min, and O2 saturation = 80% without oxygenation. The ECG showed sinus tachycardia, low-voltage limb leads, inverted T waves in two limb leads (L1 and aVL), and ST-segment depression in three pericardial leads (V1–V3). The TTE revealed LVEF = 25%, an enlarged end-diastolic diameter of the left ventricle, normal RV size (mild dysfunction), and normal valvular and pericardial function. Moreover, echocardiography demonstrated increased wall thickness. The patient had a positive nasal and oropharyngeal PCR test for COVID-19 as well as the lung CT scan showed diffuse bilateral GGO suggestive of COVID-19.\nThe patient received corticosteroids (methylprednisolone 1 mg/kg/day), broad-spectrum antibiotics (meropenem [500 mg q8 h for 5 days] and doxycycline [200 mg/day]), and remdesivir for COVID-19. The patient was discharged after 2 weeks with an ejection fraction of 45%. Follow-up of the patient for 3 months revealed an LVEF of 45% and normal RV function.