Late-onset myocardial infarction and autoimmune haemolytic anaemia in a COVID-19 patient without respiratory symptoms, concomitant with a paradoxical increase in inflammatory markers: a case report

J Med Case Rep. 2020 Dec 18;14(1):246. doi: 10.1186/s13256-020-02595-3.

Abstract

Background: In December 2019, a new coronavirus (named severe acute respiratory syndrome coronavirus 2, SARS-CoV-2) spread from China, causing a pandemic in a very short time. The main clinical presentation of SARS-CoV-2 infection (COVID-19, coronavirus disease-2019) is pneumonia, but several cardiovascular complications may also occur (e.g., acute coronary syndromes, pulmonary embolism, stroke, arrhythmias, heart failure and cardiogenic shock). Direct or indirect mechanisms induced by SARS-CoV-2 could be implicated in the pathogenesis of these events.

Case presentation: We report herein the third case of COVID-19 autoimmune haemolytic anaemia (AIHA) reported so far, which occurredwithout any other possible explanations in a Caucasian patient. The patient also suffered from ST-elevation myocardial injury.

Conclusions: Both complications occurred quite late after COVID-19 diagnosis and were probably precipitated by systemic inflammation, as indicated by a significant delayed increase in inflammatory markers, including interleukin-6 (IL-6).

Keywords: AIHA; Anaemia; COVID-19; Cardiovascular disease; IL-6; Inflammation.

Publication types

  • Case Reports

MeSH terms

  • Aged, 80 and over
  • Anemia, Hemolytic, Autoimmune / blood*
  • Anemia, Hemolytic, Autoimmune / drug therapy
  • Anemia, Hemolytic, Autoimmune / etiology
  • Anti-Bacterial Agents / therapeutic use
  • Asymptomatic Infections*
  • Azithromycin / therapeutic use
  • C-Reactive Protein / immunology*
  • COVID-19 / blood*
  • COVID-19 / complications
  • COVID-19 / immunology
  • COVID-19 Drug Treatment
  • Coombs Test
  • Electrocardiography
  • Enzyme Inhibitors / therapeutic use
  • Female
  • Glucocorticoids / therapeutic use
  • Humans
  • Hydroxychloroquine / therapeutic use
  • Interleukin-6 / immunology*
  • Platelet Aggregation Inhibitors / therapeutic use
  • Prednisolone / therapeutic use
  • SARS-CoV-2
  • ST Elevation Myocardial Infarction / diagnosis*
  • ST Elevation Myocardial Infarction / drug therapy
  • ST Elevation Myocardial Infarction / etiology

Substances

  • Anti-Bacterial Agents
  • Enzyme Inhibitors
  • Glucocorticoids
  • Interleukin-6
  • Platelet Aggregation Inhibitors
  • Hydroxychloroquine
  • Azithromycin
  • C-Reactive Protein
  • Prednisolone