Vasculitis in the Heart: Late Complication of COVID-19

COVID-19 is occasionally associated with a thrombotic microangiopathy; these microscopic blood clots in capillaries and small arteries can inflict organ damage. Reports have also emerged of a multisystem inflammatory syndrome that is similar to Kawasaki disease. Now, investigators report the experience of a patient with COVID-19 and vasculitis of the small vessels of the heart.

The patient, a 31-year-old Black woman with obesity, hypertension controlled with lisinopril, and poorly controlled diabetes, was hospitalized for COVID-19 after presenting with fever, cough, and abdominal pain. She received treatment with azithromycin and hydroxychloroquine and was discharged. After 12 days, she returned to the hospital with fever and sinus tachycardia; on computer tomography, she had enlarged parotid glands and cervical and anterior mediastinal lymphadenopathy. She tested negative for SARS-CoV-2 by polymerase chain reaction testing. Her D-dimer and C-reactive protein levels were elevated. Before she could be admitted, she became hemodynamically unstable, developed ventricular fibrillation, and died. Her autopsy showed endotheliitis and vasculitis of the small cardiac vessels, which was composed of neutrophils and CD4+>CD8+ lymphocytes. The coronary arteries and larger blood vessels were spared, but she had vascular thrombi in the lower lung.