Acute myocarditis associated with diffuse cerebral edema in a patient with Covid-19: case report
DOI:
https://doi.org/10.11606/issn.1679-9836.v103i1e-189377Keywords:
COVID-19, SARS-CoV-2, Myocarditis, Brain edemaAbstract
Infection with severe acute respiratory syndrome virus 2 (SARS-CoV-2), in addition to causing serious damage to the respiratory system, can trigger heart and brain damage. Studies suggest that both the brain parenchyma and the myocardium can be directly infected by the virus. Furthermore, the secondarily triggered hyperinflammatory state promotes endothelial, vascular and myocardial inflammation, plaque instability, hypercoagulative state and electrolyte imbalance. This paper aims to describe the case of a patient with COVID-19 with acute myocarditis associated with cerebral edema. This was a 44-year-old female patient admitted with symptoms of COVID-19. During her hospital stay, she presented elevated cardiac troponin I, as well as diffuse hypokinesia on transthoracic echocardiography, which suggested the diagnosis of myocarditis. Then, a cranial tomography showed diffuse cerebral edema and tonsillar herniation, and the patient evolved with brain death. The case reported here shows a probable impact of myocarditis on the central nervous system, and it is even less possible that low output can reduce cerebral perfusion, causing a worsening of the prognosis, due to the endogenous response process of the edema. In addition, it presents the possibility of direct damage by the virus to the myocardium and brain parenchyma, since this fact could trigger an outcome of equal severity. In this sense, there is a need for further studies to investigate the effects of SARS-CoV-2 on these tissues, as it was not possible to rule out the direct action of the virus on heart and brain tissue.
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