First case of COVID-19 complicated with fulminant myocarditis: a case report and insights

Infection. 2020 Oct;48(5):773-777. doi: 10.1007/s15010-020-01424-5. Epub 2020 Apr 10.


Background: Coronavirus disease 2019 (COVID-19) has been demonstrated to be the cause of pneumonia. Nevertheless, it has not been reported as the cause of acute myocarditis or fulminant myocarditis.

Case presentation: A 63-year-old male was admitted with pneumonia and cardiac symptoms. He was genetically confirmed as having COVID-19 according to sputum testing on the day of admission. He also had elevated troponin I (Trop I) level (up to 11.37 g/L) and diffuse myocardial dyskinesia along with a decreased left ventricular ejection fraction (LVEF) on echocardiography. The highest level of interleukin-6 was 272.40 pg/ml. Bedside chest radiographs showed typical ground-glass changes indicative of viral pneumonia. Laboratory test results for viruses that cause myocarditis were all negative. The patient conformed to the diagnostic criteria of the Chinese expert consensus statement for fulminant myocarditis. After receiving antiviral therapy and mechanical life support, Trop I was reduced to 0.10 g/L, and interleukin-6 was reduced to 7.63 pg/mL. Moreover, the LVEF of the patient gradually recovered to 68%. The patient died of aggravation of secondary infection on the 33rd day of hospitalization.

Conclusion: COVID-19 patients may develop severe cardiac complications such as myocarditis and heart failure. This is the first report of COVID-19 complicated with fulminant myocarditis. The mechanism of cardiac pathology caused by COVID-19 needs further study.

Keywords: COVID-19; Coronavirus; Echocardiography; Fulminant myocarditis; Infection.

Publication types

  • Case Reports

MeSH terms

  • Acute Disease
  • Antiviral Agents / therapeutic use
  • Bacteroides Infections / complications*
  • Bacteroides Infections / diagnostic imaging
  • Bacteroides Infections / drug therapy
  • Bacteroides Infections / virology
  • Betacoronavirus / drug effects
  • Betacoronavirus / pathogenicity*
  • Biomarkers / blood
  • COVID-19
  • Candidiasis / complications*
  • Candidiasis / diagnostic imaging
  • Candidiasis / drug therapy
  • Candidiasis / virology
  • Coronavirus Infections / complications*
  • Coronavirus Infections / diagnostic imaging
  • Coronavirus Infections / drug therapy
  • Coronavirus Infections / virology
  • Drug Combinations
  • Echocardiography
  • Fatal Outcome
  • Humans
  • Interleukin-6 / blood
  • Lopinavir / therapeutic use
  • Male
  • Middle Aged
  • Myocarditis / complications*
  • Myocarditis / diagnostic imaging
  • Myocarditis / drug therapy
  • Myocarditis / virology
  • Pandemics
  • Piperacillin, Tazobactam Drug Combination / therapeutic use
  • Pneumonia, Viral / complications*
  • Pneumonia, Viral / diagnostic imaging
  • Pneumonia, Viral / drug therapy
  • Pneumonia, Viral / virology
  • Ritonavir / therapeutic use
  • SARS-CoV-2
  • Stroke Volume / drug effects
  • Tomography, X-Ray Computed
  • Troponin I / blood


  • Antiviral Agents
  • Biomarkers
  • Drug Combinations
  • IL6 protein, human
  • Interleukin-6
  • Troponin I
  • lopinavir-ritonavir drug combination
  • Piperacillin, Tazobactam Drug Combination
  • Lopinavir
  • Ritonavir