Heart failure secondary to myocarditis after SARS-CoV-2 reinfection: a case report

Patrícia Gabriela Riedel; Vitoria Fedrizzi Sakai; Sheila de Castro Cardoso Toniasso; Maria Carlota Borba Brum; Fernando Schmidt Fernandes; Robson Martins Pereira; Camila Pereira Baldin; Cícero de Campos Baldin; Anderson Yudi Takahasi; Hugo Shiki; Ana Maria Rocha Krepsky; Damasio Trindade Macedo; Álvaro Roberto Crespo Merlo; Luis Eduardo Paim Rohde; Dvora Joveleviths

doi:10.1016/j.ijid.2021.10.031

Heart failure secondary to myocarditis after SARS-CoV-2 reinfection: a case report

Int J Infect Dis. 2021 Dec:113:175-177. doi: 10.1016/j.ijid.2021.10.031. Epub 2021 Oct 21.

Authors

Patrícia Gabriela Riedel¹, Vitoria Fedrizzi Sakai², Sheila de Castro Cardoso Toniasso³, Maria Carlota Borba Brum⁴, Fernando Schmidt Fernandes⁵, Robson Martins Pereira⁶, Camila Pereira Baldin⁷, Cícero de Campos Baldin⁸, Anderson Yudi Takahasi⁹, Hugo Shiki¹⁰, Ana Maria Rocha Krepsky¹¹, Damasio Trindade Macedo¹², Álvaro Roberto Crespo Merlo¹³, Luis Eduardo Paim Rohde¹⁴, Dvora Joveleviths¹⁵

Affiliations

¹ Medical student, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil. Electronic address: priedel@hcpa.edu.br.
² Medical student, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil. Electronic address: vsakai@hcpa.edu.br.
³ Physician, Occupational Medicine Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil. Electronic address: stoniasso@hcpa.edu.br.
⁴ Physician, Occupational Medicine Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil. Electronic address: mcbrum@hcpa.edu.br.
⁵ Physician, Occupational Medicine Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil. Electronic address: fscfernandes@hcpa.edu.br.
⁶ Physician, Occupational Medicine Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil. Electronic address: rompereira@hcpa.edu.br.
⁷ Physician, Occupational Medicine Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil. Electronic address: cbaldin@hcpa.edu.br.
⁸ Physician, Hospital Mãe de Deus de Porto Alegre, Rio Grande do Sul, Brazil. Electronic address: cicero.baldin@gmail.com.
⁹ Resident, Medical Residency Program in Occupational Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil. Electronic address: atakahasi@hcpa.edu.br.
¹⁰ Resident, Medical Residency Program in Occupational Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil. Electronic address: hshiki@hcpa.edu.br.
¹¹ Physician, Cardiology Medicine Service at Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil. Electronic address: akrepsky@hcpa.edu.br.
¹² Professor of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil. Electronic address: dtrindade@hcpa.edu.br.
¹³ Professor of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil. Electronic address: amerlo@hcpa.edu.br.
¹⁴ Professor of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil. Electronic address: lerohde@hcpa.edu.br.
¹⁵ Professor of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil. Electronic address: djoveleviths@hcpa.edu.br.

Abstract

Introduction: Cardiac involvement in COVID-19 can range from mild damage to severe myocarditis. The precise mechanism by which COVID-19 causes myocardial injury is still unknown. Myocarditis following administration of COVID-19 vaccines, especially those based on mRNA, has also been described. However, no reports of heart failure following reinfection with SARS-CoV-2 in patients immunized with an inactivated vaccine have been identified.

Case description: The patient was a 47-year-old male construction worker of African descent, with type II diabetes and a history of infection by SARS-CoV-2 in December 2020 and May 2021, confirmed by RT-PCR. He received two doses of an inactivated vaccine against COVID-19. Between the two COVID-19 episodes with positive RT-PCR, he had two episodes of bacterial lung infection. After the second episode of SARS-CoV-2 infection, he was diagnosed with severe heart failure as a sequela of myocarditis.

Conclusion: It is essential to perform a thorough follow-up after infection with SARS-CoV-2 since, even with proper immunization, it is possible that the patient was reinfected and suffered severe cardiac sequelae as a consequence. The hypothesis of an etiology associated with the use of an inactivated vaccine against COVID-19, with a potential immune enhancement mechanism following reinfection with SARS-CoV-2, cannot be rejected.

Keywords: COVID-19; SARS-CoV-2; heart failure; myocarditis; vaccine.

Publication types

Case Reports

MeSH terms

COVID-19 Vaccines
COVID-19*
Diabetes Mellitus, Type 2*
Heart Failure* / etiology
Humans
Male
Middle Aged
Myocarditis* / etiology
Reinfection
SARS-CoV-2

Substances

COVID-19 Vaccines