Heart failure secondary to myocarditis after SARS-CoV-2 reinfection: a case report

Riedel, Patrícia Gabriela; Sakai, Vitoria Fedrizzi; Castro Cardoso Toniasso, Sheila de; Brum, Maria Carlota Borba; Fernandes, Fernando Schmidt; Pereira, Robson Martins; Baldin, Camila Pereira; Baldin, Cícero de Campos; Takahasi, Anderson Yudi; Sakai, Hugo; Kresky, Ana Maria Rocha; Macedo, Damasio Trindade; Merlo, Álvaro Roberto Crespo; Rohde, Luis Eduardo Paim; Joveleviths, Dvora

Introduction: Cardiac involvement in COVID-19 can range from mild damage to severe myocarditis. The precise mechanism by which COVID-19 causes myocardial injury is still unknown. Myocarditis following administration of COVID-19 vaccines, especially those based on mRNA, has also been described. However, no reports of heart failure following reinfection with COVID-19 in patients immunized with an inactivated vaccine have been identified. Case description: Male, 47-year-old, of African descent, construction worker, with type II diabetes, with a history of infection by SARS-CoV-2 in December 2020 and May 2021, confirmed by RT-PCR. Received two doses of an inactivated vaccine against COVID-19. Between the two COVID-19 episodes with positive RT-PCR he had two episodes of bacterial lung infection. After the second episode of SARS-CoV-2 infection, he was diagnosed with severe heart failure as a sequelae of myocarditis. Conclusion: It is essential to do a proper follow-up after infection by SARS-CoV-2, since even with proper immunization, there is a possibility that the patient was reinfected and had severe cardiac sequelae as a consequence, and the hypothesis of an etiology associated with the use of an inactivated vaccine against COVID-19 with a potential immune enhancement mechanism following re-infection with SARS-CoV-2 cannot be rejected.