Case 3: Diffuse ST-segment elevation
A 16-year-old male was admitted with fever (for one week before admission), diarrhea, and dry coughs. He was in shock (low blood pressure (80/60 mmHg), non-palpable pulsation, and cyanosis). The oxygen saturation was 85% without an oxygen supply. ECG showed a normal sinus rhythm with diffuse anterior ST-segment elevations in precordial leads (Figure 2). The patient was intubated, and vasopressors were initiated, which lead to a rapid resolution of the ECG abnormality. Echocardiography showed a left ventricular wall thickness, LVEF of 20-25% with generalized hypokinesia, normal RV size (and function), and a dilated inferior vena cava. Also, valvular structure and function were normal. CT scan showed GGO (Figure 1C).
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. The patient died the next day to admission due to sudden bradycardia, hypotension, and cardiac arrest.