Myocarditis, a Life-Threatening Presentation of COVID-19 in a 4-Month-Old Infant

Background and Aim: Significant cardiac sequelae may be one of the main causes of death in COVID-19 patients; however, very few reports are available that address these complications and their treatment strategies in children. Case Presentation: A 4-month-old male infant was admitted to the pediatric intensive care unit with sudden tachycardia, tachypnea, and low oxygen saturation after surgery. Laboratory tests and echocardiography revealed elevated troponin I levels and myocardial dyskinesia with decreased Left Ventricular Ejection Fraction (LVEF= 50%) and pulmonary hypertension (30 mm Hg) consistent with the cardiac injury. Despite his normal chest x-ray, the chest CT scan disclosed ground-glass opacities in the periphery of the left lower lobe indicative of viral infection. The patient fulfilled the diagnostic criteria of the “Chinese expert consensus statement for clinical myocarditis”. The viral test for COVID-19 obtained on the first day of admission was found positive a few days later. The patient successfully recovered clinically after receiving anti-failure therapy and IVIG. Trop I level reduced to 0.10 g/L, and the LVEF eventually recovered to 68%. Conclusion: COVID-19 patients may develop severe cardiac complications such as myocarditis and heart failure. Myocarditis in this patient was treated without antiviral drugs and only with supportive therapies.