Abstract
BACKGROUND Subacute thyroiditis, myocarditis, and hepatitis are inflammatory disorders that may develop after viral infections, including SARS-CoV-2. These entities may appear after resolution of the respiratory syndrome. CASE REPORT A previously healthy 64-year-old male patient came to the hospital reporting severe chest pain. He had a history of a COVID-19 pneumonia with PCR confirmation 4 weeks before. On admission to the Coronary Care Unit (CCU), the patient had a negative PCR for SARS-CoV-2; the following tests were performed: total T3 643.4 ng/dl (reference 35-193 ng/dl), total thyroxine 12.0 μg/dl (reference 4.8-11.7 μg/dl), free T4 1.85 ng/dl (reference 0.7-1.48 ng/dl), TSH 0.01 μIU/ml (reference 0.35-4.94 μIU/ml); total bilirubin 0.76 mg/dl (reference 0.0-1.5 mg/dl), alkaline phosphatase 185 U/L (reference 40-150 U/L), alanine aminotransferase 194.6 U/L (reference 6-66 U/L), aspartate aminotransferase 93.4 U/L (reference 9-55 U/L); on admission to the CCU high-sensitivity troponin I 548.3 pg/ml (reference 0.0-34.2 pg/ml), after 24 h in the CCU 801 pg/ml, and after 11 days (as an outpatient) 4.5 pg/ml. A thyroid gammagram revealed absent uptake of the radionuclide. Normal cardiac gammagraphy and cardiac enzymes ruled out myocardial ischemia and infarction. The following diagnoses were made: myocarditis, subacute thyroiditis, and reactive hepatitis due to SARS-CoV-2 infection. CONCLUSIONS COVID-19 has been demonstrated to be a multisystemic inflammatory disorder. The serious illness that developed in our patient after relief of his pulmonary disease underlines this nature. We suggest close follow-up of patients even after apparent clinical resolution, and performing thyroid, myocardial, and liver tests if clinically indicated.
【초록키워드】 COVID-19, SARS-CoV-2, COVID-19 pneumonia, Pneumonia, SARS-COV-2 infection, hospital, troponin, viral infections, Viral, PCR, Hepatitis, myocarditis, male, Patient, Aspartate aminotransferase, Follow-up, Thyroid, Thyroiditis, troponin I, Admission, diagnose, pulmonary disease, Outpatient, Inflammatory, Bilirubin, Infarction, chest pain, on admission, thyroxine, alanine aminotransferase, inflammatory disorders, phosphatase, alkaline phosphatase, Liver tests, Myocardial ischemia, Subacute, inflammatory disorder, following tests, Coronary Care Unit, free T4, total bilirubin, relief, syndrome, aspartate, Alanine, Negative PCR, multisystemic, unit, disorder, Myocardial, radionuclide, TSH, reactive, cardiac enzymes, normal, following test, develop, healthy, indicated, the patient, clinically, demonstrated, CCU, Coronary, cardiac enzyme, liver test, 【제목키워드】 COVID-19, Resolution, Subacute, Serum Marker,