Working Paper Case Report Version 2 This version is not peer-reviewed

First Case of COVID-19 Complicated with Fulminant Myocarditis: A case Report and Insights

Version 1 : Received: 10 March 2020 / Approved: 11 March 2020 / Online: 11 March 2020 (04:57:10 CET)
Version 2 : Received: 3 April 2020 / Approved: 7 April 2020 / Online: 7 April 2020 (01:03:22 CEST)

A peer-reviewed article of this Preprint also exists.


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.


COVID-19; coronavirus; fulminant myocarditis; infection; echocardiography.


Biology and Life Sciences, Virology

Comments (1)

Comment 1
Received: 7 April 2020
Commenter: Jia Hui Zeng
Commenter's Conflict of Interests: Author
Comment: List of Actions
LOA1: Since “2019-nCoV” had been renamed as “SARS-CoV-2”, and the disease caused by the virus had been renamed as “Coronavirus Disease 2019”, abbreviated as “COVID-19”, we would like to change our manuscript title as “First case of COVID-19 complicated with fulminant myocarditis: a case report and insights”. The expression in the article has also been made corresponding changes.

LOA2: At the time of initial submission, the patient was still under treatment. At the time of revision, the patient had died. Therefore, the case report and corresponding chart are updated to the date of death in this revision.

LOA3: The highest level of troponin I is added in the abstract (page 4, line 19).

LOA4: The unit of creatinine level have been corrected to µmol/l (page 5, line 41).

LOA5: “Myocardial enzyme” has been changed into “Markers of myocardial injury” (page 6, line 7) (page 9, line 27) (page 13, line 24).

LOA6: The updated proportion of increased myocardial injury markers observed in the COVID-19 patients of our hospital is added (page 8, line 3).

LOA7: The parameters supporting the ECMO indication are mentioned in the fourth section of case report (page 6, line25).

LOA8: Studies about other respiratory viruses can also cause heart damage have been cited (page 8, line13).

LOA9: The role of CRRT and ECMO is added in the third section of discussion (page 9, line3).

LOA10: All typos have been removed.
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