A 46-year-old athletic and otherwise healthy Caucasian male with a past medical history of mild hyperlipidemia was diagnosed with COVID-19 on March 17, 2020. He had symptoms of malaise, dry cough, anosmia, and a low-grade fever for 2 days prior to his test. His symptoms were self-limited and fully abated on day 5 after onset. He did not require supportive oxygen or hospitalization. Due to his self-limited illness, there were no laboratory data acquired such as cardiac biomarkers. He did not warrant nor was he treated with any pharmacotherapies or antibiotics. His baseline electrocardiogram (ECG) was reported normal including the QT interval. He resumed normal activity after resolution of his illness that month including vigorous aerobic exercise for the following 2–3 months and felt very close to his normal baseline functional status.
Approximately 3 months after resolution of illness (June 2020), he began having frequent palpitations and exertional dyspnea. He attributed his symptoms to anxiety and some deconditioning from prior quarantine. He had COVID-19 antibodies checked at that time, which showed high titers. On month 4 after his diagnosis (July 2020), he had a chest x-ray, electrocardiogram, and echocardiogram which were all unremarkable. He underwent continuous Holter monitoring which showed frequent premature ventricular beats and multiple brief paroxysms of non-sustained ventricular tachycardia. His baseline ECG remained normal, as shown (Figure 1). In September of the same year (month 7 following illness), his repeat ECG showed subtle abnormalities (Figure 2).
Electrocardiogram (ECG) 1, August 6, 2020, performed 5 months after illness reveals normal sinus rhythm. Prior ECGs were all normal as well
Electrocardiogram, September 8, 2020, reveals sinus rhythm with nonspecific ST changes inferiorly (arrows) and a rightward axis
At 5 months and 28 days after his illness, he underwent CMR using the General Electric Signa Artist 1.5 Tesla with field of view 36 x 32 mm, slice thickness 8 mm, 0 mm spacing, matrix 200 x 200 pixels mm, number of excitations 1. Gadolinium-enhanced imaging was performed approximately 10 min after administration of 0.1 mmol/kg body weight of gadobutrol (Gadovist; Bayer). Findings showed normal left and right ventricular systolic function with mild left ventricular hypertrophy, with prominent LGE involving epicardial and pericardial fibrosis of the basal to apical anterior wall and at the basal to mid anterior septum and right ventricular free wall with a trivial pericardial effusion (Figures 3, 4, 5).
Cardiovascular magnetic resonance imaging, fast gradient echo, two-chamber view showing late gadolinium enhancement of the pericardium over the left ventricular anterior wall (arrow) and a trivial pericardial effusion (small arrow). Star denotes left ventricular cavity. Star denotes the left ventricle
Cardiovascular magnetic resonance imaging, fast gradient echo, short-axis view from basal segment (a) to mid segment (b) showing late gadolinium enhancement of the pericardium over the anterior and anteroseptal walls (arrows). Star denotes left ventricular cavity. Star denotes the left ventricle
Cardiovascular magnetic resonance imaging, fast gradient echo, short-axis view of the mid to apical segment showing late gadolinium enhancement of the free wall of the right ventricle (a) and pericardium over the anterior wall, lateral wall (b) (arrows). Star denotes left ventricular cavity. Star denotes the left ventricle
J Med Case Reports. 2021;15(305) © 2021 BioMed Central, Ltd.