Case 2: Abdominal pain
A 15-year-old female (without underlying diseases) was admitted with mild dyspnea, abdominal pain, nausea, and fever (from two days before administration). At the time of admission, vital signs included temperature = 39.8, systolic blood pressure = 90/50 mmHg, heart rate = 120/min, and O2 saturation = 95% without an oxygen supply. In physical examination, filiform pulse and cold limbs were observed. ECG revealed sinus tachycardia and inverted T wave in lateral limb and precordial leads. Abdominal ultrasound showed an enlarged liver span (146 mm) in favor of acute hepatitis. TTE revealed severe ventricular (RV and LV) enlargement and dysfunction (LVEF = 5-10%), a moderate degree of mitral regurgitation, PAP = 35 mmHg, and mild pericardial effusion. Chest CT scan revealed bilateral GGO and peripheral consolidations (Figure 1B). The patient was treated with broad-spectrum antibiotics, corticosteroids (1 mg/kg methylprednisolone/day), and remdesivir. The patient was discharged ten days later in stable condition, with normalized WBC count and liver enzymes. TTE revealed no change compared to the initial evaluation. However, following up the patient for three months revealed LVEF of 20% and dysfunctional and enlarged RV. Also, the patient suffered from dyspnea during ordinary activities (function class II).