Case Report: The Challenge for Diagnosis of Myocarditis and Transplant Rejection After COVID Infection in a Heart-Transplanted Adolescent

• DOI: 10.1016/j.transproceed.2023.06.003
• Publication Date: 2023-07-27T20:04:13Z
• Authors: Helio Milani Pegado; Adailson Siqueira; Joshua Navarajase...; Luiz Alberto Benv...; Claudia Regina Pi...; Santiago Raul Arr...; Paulo Sampaio Gut...; Marisa Dolhnikoff; Vera Demarchi Aiello; Marcelo Biscegli ...; Estela Azeka
• Keywords: Immunosuppression; Endomyocardial Biopsy; Transplant rejection

Patients who have undergone organ transplantation are immunosuppressed hosts, leaving them at a higher risk of infections. SARS-COV-2 has been shown to affect heart-transplanted patients. In this case report, we present the case of a 14-year-old heart transplant recipient who developed signs and symptoms of heart failure, along with fatigue, after a COVID-19 infection. An endomyocardial biopsy was performed to diagnose rejection and to evaluate whether this was myocarditis due to SARS-COV-2. The biopsy showed intense acute cellular rejection (3R) and antibody rejection PAMR1 H+ but was negative for the SARS-CoV-2 virus. The patient received organ rejection therapy with high-dose methylprednisolone and human immunoglobulin. After treatment, her heart function recovered, with biopsy investigations showing a lower level of cellular rejection (1R).