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COVID-19 Pneumonia in Patients with Chronic Myocarditis (Recurrent Infectious Immune): Specifics of the Diseases Course, the Role of Basic Therapy (Part 1)

https://doi.org/10.20996/1819-6446-2020-08-16

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Abstract

Patients with chronic myocarditis have a high risk of an unfavorable course of the novel coronavirus disease (COVID-19) due to the ability of the SARS-Cov-2 virus to independently cause acute myocarditis, to have a direct and cytokine-mediated cytopathic effect on the myocardium, as well as immunosuppressive therapy. At the same time, the features of the interaction of chronic myocarditis and COVID-19 have not been studied. The article describes a 31-year-old patient with a 10-year history of chronic recurrent infectious-immune myocarditis, who was on long-term immunosuppressive therapy (methylprednisolone and azathioprine in the past, then hydroxychloroquine). In May 2020, a serologically confirmed COVID-19 diagnosis was made. There were risk factors for the unfavorable course of coronavirus infection: heart failure and a history of persistent atrial fibrillation, male sex. Basic therapy with hydroxychloroquine (with an increase in its dose to 800-400 mg/day), ceftriaxone, and levofloxacin was carried out. The severity of pneumonia was moderate, despite febrile fever and severe intoxication. No relapses of arrhythmias, respiratory or heart failure were observed. Minimal laboratory (some increase in anticardial antibody titers) and echocardiographic signs of exacerbation of myocarditis without an increase in troponin T levels were revealed, which quickly regressed. It can be assumed that the maintenance immunosuppressive therapy of myocarditis with hydroxychloroquine had a positive effect on the course of coronavirus pneumonia and made it possible to avoid recurrence of myocarditis. Further study of the features of the course of the pre-existing myocarditis and pneumonia in COVID-19 is necessary.

About the Authors

O. V. Blagova
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Olga V. Blagova – MD, PhD, Professor, Chair of Faculty Therapy №1; Doctor, Department for Patients with New Coronavirus Infection, University Clinical Hospital №1

Trubetskaya ul. 8-2, Moscow, 119991



N. V. Varionchik
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Nadezhda V. Varionchik – MD, Senior Assistant, Chair of Faculty Therapy №1; Doctor, Department for Patients with New Coronavirus Infection, University Clinical Hospital №1

Trubetskaya ul. 8-2, Moscow, 119991



M. M. Beraia
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Maka M. Beraia – MD, PhD, Doctor, Department for Patients with New Coronavirus Infection, University Clinical Hospital №1

Trubetskaya ul. 8-2, Moscow, 119991



V. A. Zaidenov
City Clinical Hospital № 52
Russian Federation

Vladimir A. Zaidenov – MD, PhD, Doctor, Laboratory of Immunohistochemistry

Pehotnaya ul. 3, Moscow, 123182



E. A. Kogan
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Evgeniya A. Kogan – MD, PhD, Professor, Head of Chair of Pathology named after Academician A.I. Strukov

Trubetskaya ul. 8-2, Moscow, 119991



N. D. Sarkisova
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Natalia D. Sarkisova – MD, PhD, Head of Department for Patients with New Coronavirus Infection, University Clinical Hospital №1

Trubetskaya ul. 8-2, Moscow, 119991



A. V. Nedostup
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Alexander V. Nedostup – MD, PhD, Professor, Researcher, Cardiology Research Department, Biomedical Science and Technology Park

Trubetskaya ul. 8-2, Moscow, 119991



References

1. Huang C., Wang Y., Li X., et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. DOI:10.1016/S0140-6736(20)30183-5.

2. Griffiths P., Baraniak I., Reeves M. The Pathogenesis of Human Cytomegalovirus. J Pathol. 2015;235(2):288-97. DOI:10.1002/path.4437.

3. Wang D., Hu B., Hu C., et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-9. DOI:10.1001/jama.2020.1585.

4. Gao J., Tian Z., Yang X. Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Biosci Trends. 2020;14(1):72-3. DOI:10.5582/bst.2020.01047.

5. Gautret P., Lagier J.C., Parola P., et al. Hydroxychloroquine and azithromycin as a treatment of COVID19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents. 2020;56(1):105949. DOI:10.1016/j.ijantimicag.2020.105949.

6. Mehra M.R., Desai S.S., Ruschitzka F., Patel A.N. Hydroxychloroquine orchloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis. Lancet. 2020 May 22:S0140-6736(20)31180-6. DOI:10.1016/S0140-6736(20)31180-6.

7. Mehra M.R., Ruschitzka F., Patel A.N. Retraction-Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis. Lancet. 2020;395(10240):1820. DOI:10.1016/S0140-6736(20)31324-6.

8. Monti S., Balduzzi S., Delvino P., et al. Clinical course of COVID-19 in a series of patients with chronic arthritis treated with immunosuppressive targeted therapies. Ann Rheum Dis. 2020;79(5):667-8. DOI:10.1136/annrheumdis-2020-217424.

9. Gianfrancesco M., Hyrich K.L., Al-Adely S., et al. Characteristics Associated With Hospitalisation for COVID-19 in People With Rheumatic Disease: Data From the COVID-19 Global Rheumatology Alliance Physician-Reported Registry. Ann Rheum Dis. 2020;79(7):859-66. DOI:10.1136/annrheumdis2020-217871.

10. Blagova O.V., Nedostup A.V., Kogan E.A. Myocardial and pericardial diseases: from syndromes to diagnosis and treatment. Moscow: GEOTAR-Media; 2019 (In Russ.) ISBN 978-5-9704-4743-7.

11. Sahraei Z., Shabani M., Shokouhi S., Saffaeie А. Aminoquinolines against coronavirus disease 2019 (COVID-19): chloroquine or hydroxychloroquine. Int J Antimicrob Agents. 2020;55(4):105945. DOI:10.1016/j.ijantimicag.2020.105945.

12. Arshad S., Kilgore P., Chaudhry Z.S., et al. Treatment with Hydroxychloroquine, Azithromycin, and Combination in Patients Hospitalized with COVID-19. Int J Infect Dis. 2020;97:396-403. DOI:10.1016/j.ijid.2020.06.099.

13. Karavidas A., Lazaros G., Noutsias M., et al. Recurrent Coxsackie B Viral Myocarditis Leading to Progressive Impairment of Left Ventricular Function Over 8 Years. Int J Cardiol. 2011;151(2):e65-7. DOI:10.1016/j.ijcard.2010.05.030.

14. Alotaibi A.M., Aljizeeri A., Al-Mallah M., et al. Utility of cardiac magnetic resonance in recurrent myocarditis. J Saudi Heart Assoc. 2017;29(3):214-8. DOI:10.1016/j.jsha.2016.08.002.


For citation:


Blagova O.V., Varionchik N.V., Beraia M.M., Zaidenov V.A., Kogan E.A., Sarkisova N.D., Nedostup A.V. COVID-19 Pneumonia in Patients with Chronic Myocarditis (Recurrent Infectious Immune): Specifics of the Diseases Course, the Role of Basic Therapy (Part 1). Rational Pharmacotherapy in Cardiology. 2020;16(4):550-556. (In Russ.) https://doi.org/10.20996/1819-6446-2020-08-16

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ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)