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).