Fulminant myocarditis induced by SARS-CoV-2 infection without severe lung involvement: insights into COVID-19 pathogenesis

Han Du; Zhongtao Du; Liang Wang; Hong Wang; Mingjun Jia; Chunge Zhang; Yun Liu; Cheng Zhang; Ya Zhang; Ruifeng Zhang; Shuang Zhang; Ning Zhang; Zhenghai Ma; Chen Chen; Wenjun Liu; Hui Zeng; George F. Gao; Xiaotong Hou; Yuhai Bi

doi:10.1016/j.jgg.2024.02.007

Volume 51 Issue 6

Jun. 2024

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Article Navigation > Journal of Genetics and Genomics > 2024 > 51(6): 608-616

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Fulminant myocarditis induced by SARS-CoV-2 infection without severe lung involvement: insights into COVID-19 pathogenesis

doi: 10.1016/j.jgg.2024.02.007

a. College of Life Science and Technology, Xinjiang University, Urumchi, Xinjiang 830046, China;
b. CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Center for Influenza Research and Early-warning (CASCIRE), CAS-TWAS Center of Excellence for Emerging Infectious Diseases (CEEID), Chinese Academy of Sciences, Beijing 100101, China;
c. Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China;
d. College of Veterinary Medicine, Shanxi Agricultural University, Taiyuan, Shanxi 030031, China;
e. University of Chinese Academy of Sciences, Beijing 100049, China;
f. Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China

Funds:

This work was supported by the National Key R&

D Program of China (2023YFC2307500 and 2021YFC2701700), National Natural Science Foundation of China (82341115), Beijing Research Center for Respiratory Infectious Diseases (BJRID2024-003), Major Project of Guangzhou National Laboratory (GZNL2023A01001 and SRPG22-001), and the National Science and Technology Infrastructure of China (National Pathogen Resource Center-NPRC-32). Y. B. is supported by the Youth Innovation Promotion Association of CAS (Y2021034), CAS Project for Young Scientists in Basic Research (YSBR-086), and the Innovation Team and Talents Cultivation Program of the National Administration of Traditional Chinese Medicine (ZYYCXTD-D-202208).

Received Date: 2023-11-17
Accepted Date: 2024-02-26
Rev Recd Date: 2024-02-23

Available Online: 2025-06-06

Publish Date: 2024-03-04

Abstract

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection often leads to pulmonary complications. Cardiovascular sequelae, including myocarditis and heart failure, have also been reported. Here, the study presents two fulminant myocarditis cases infected by SARS-CoV-2 exhibiting remarkable elevation of cardiac biomarkers without significant pulmonary injury, as determined by imaging examinations. Immunohistochemical staining reveals the viral antigen within cardiomyocytes, indicating that SARS-CoV-2 could directly infect the myocardium. The full viral genomes from respiratory, anal, and myocardial specimens are obtained via next-generation sequencing. Phylogenetic analyses of the whole genome and spike gene indicate that viruses in the myocardium/pericardial effusion and anal swabs are closely related and cluster together yet diverge from those in the respiratory samples. In addition, unique mutations are found in the anal/myocardial strains compared to the respiratory strains, suggesting tissue-specific virus mutation and adaptation. These findings indicate genetically distinct SARS-CoV-2 variants have infiltrated and disseminated within myocardial tissues, independent of pulmonary injury, and point to different infection routes between the myocardium and respiratory tract, with myocardial infections potentially arising from intestinal infection. These findings highlight the potential for systemic SARS-CoV-2 infection and the importance of a thorough multi-organ assessment in patients for a comprehensive understanding of the pathogenesis of COVID-19.
- COVID-19,
- SARS-CoV-2,
- Fulminant myocarditis,
- Myocardium,
- Infection

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References(53)

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