An 18-year-old woman (with no underlying disease) was admitted with a sudden loss of consciousness, fever, and headache that had occurred for 2 days before admission. At the time of admission, vital signs were as follows: body temperature = 36.8°C, systolic blood pressure = 80/60 mmHg, heart rate = 110/min, and O2 saturation = 80% without oxygenation. Glasgow Coma Scale (GCS) score was 11. She was intubated and treated with vasopressors. Also, rales were heard on pulmonary auscultation. Initial electrocardiogram (ECG) demonstrated sinus tachycardia (110/min) and low voltage QRS. Transthoracic echocardiography (TTE) indicated a small left ventricle (LV) with an end-diastolic dimension of 42 mm, a left ventricular ejection fraction (LVEF) of 10% with global hypokinesis, a normal right ventricle (RV), and pulmonary arterial pressure (PAP), no pericardial effusion (PE) or thrombosis, and no significant valve lesions or dysfunction. Chest computed tomography (CT) scan revealed diffuse bilateral ground-glass opacities (GGO) and basal consolidations (Figure ). Moreover, the patient had a positive nasal and oropharyngeal polymerase chain reaction (PCR) test for COVID-19. Laboratory findings are summarized in Table . The patient received intravenous immunoglobulin (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. However, she died due to cardiac arrest (less than 24 h after admission).
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.