A 45-year-old man was admitted with a fever that lasted for 2 weeks, dyspnea, and pleuritic chest pain continued for 1 week. Vital signs were as follows: body temperature = 38.5°C, systolic blood pressure = 100/70 mmHg, heart rate = 90/min and, O2 saturation = 85% without oxygenation (90% with nasal oxygen therapy). The ECG showed sinus tachycardia, no significant changes in the ST-segment, low-voltage waves in the limb leads, and QRS alternans. The TTE revealed LVEF of 45%, normal LV size and function without regional wall motion abnormalities, and circumferential pericardial effusion without significant respiratory changes in the mitral and tricuspid valves (Figure ). Lung CT scan showed bilateral GGO suggestive of viral pneumonia (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]), corticosteroid (methylprednisolone 1 mg/kg/day), and remdesivir for COVID-19. However, the pericardial effusion was resolved by the third day after admission. Oxygen saturation increased to 95% after 5 days (without supplemental oxygen) and he was discharged in a satisfying condition. Follow-up of the patient for 3 months showed an LVEF of 45%, mild pericardial effusion, and normal right ventricular size and function.
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).