This Commentary refers to: ‘Coronavirus fulminant myocarditis saved with glucocorticoid and human immunoglobulin’, by H. HuWe are glad to share our point of view on the case published in the European Heart Journal. Diarrhoea (also a common symptom of viral infection) is the prodrome in this case. Coronavirus nucleic acid test was positive for the respiratory tract specimens and coronavirus infection was in turn considered. However, there was no obvious cough and hypoxaemia during the disease course and chest CT showed no signs of viral infection in either lung. The diagnosis of viral pneumonia could not be established. The aetiological evidence of viral myocarditis can come from the detection of virus in the myocardium, blood, and other organs of the patient. However, it is often difficult to obtain the virological evidence in myocardium and blood, and it is relatively easy to obtain this evidence from body fluids, secretions, and excreta. In this case, it is reasonable to diagnose myocarditis caused by coronavirus after this virus was detected in respiratory tract samples.The patient had no COVID-19-related epidemiology history and the detected coronavirus RNA sequence is different from that of SARS-CoV-2 which causes COVID-19. At that time, regarding the detection of respiratory pathogens carried out by our hospital, the detection of coronavirus included four common humaninfectioncoronaviruses, namely HCov-229E (alpha genus), HCoV-NL63 (alpha genus), HCoV-HKU1 (beta genus), and HCoV-OC43 (beta genus). The PCR primer probe detected by this method was specific and had hardly any cross-reaction with three other coronaviruses (SARS, MERS, and SARS-CoV-2). We did not have the SARS-CoV-2 test kit at that time, and this patient was discharged soon after recovery, so a nucleic acid test for SARS-CoV-2 was not done in this patient.So we conclude that this patient had coronavirus fulminant myocarditis with little possibility of being infected with SARS-CoV-2. However, because they belong to the coronavirus family and have certain degrees of homology, it is presumed that SARS-CoV-2 may have a similar pathogenicity effect in this type of patient.
Funding
National Key R&D Program of China. Award number: 2017YFC1307800.Conflict of interest: none declared.