Case 1: Loss of consciousness
An 18-year-old female (without underlying diseases) was admitted with a sudden loss of consciousness. She experienced fever and headache from two days before the admission. At the time of admission, vital signs included temperature = 36.8, systolic blood pressure = 80/60 mmHg, heart rate=110/min, and O2 saturation = 80% without an oxygen supply. She went under intubation and vasopressors therapy. Also, rales were significant in pulmonary auscultation. The initial electrocardiogram (ECG) showed sinus tachycardia (110/minute) and low voltage QRS. Transthoracic echocardiography (TTE) demonstrated a small left ventricle (LV) with an end-diastolic dimension of 42mmm, left ventricular ejection fraction (LVEF) of 10% with global hypokinesia, a normal right ventricle (RV) and pulmonary arterial pressure (PAP), no pericardial effusion (PE) or LV thrombosis, and no significant valvular lesions or dysfunction. Chest CT scan revealed diffuse bilateral ground-glass opacities (GGO) and basal consolidations (Figure 1A). Laboratory findings are summarized in Table 1. The patient received IVIG (1 gram), broad-spectrum antibiotics (meropenem and doxycycline), high-dose corticosteroid (1 mg/kg methylprednisolone/day), and remdesivir for COVID-19. However, she died due to cardiac arrest (less than 24 hours after admission).