Vahideh Laleh Far1, Seyed Reza Najafizadeh2, Masoud Eslami1, Reza Mollazadeh1. 1. Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. 2. Department of Rheumatology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
A 23-year old woman was admitted to our hospital during the COVID-19 outbreak in June 2020 due to new-onset chest discomfort, dyspnoea, and papulo-vesicular lesions in her extremities.She was a known case of ‘idiopathic hypereosiniphilic syndrome’ since 4 years previously. Secondary aetiologies of hypereosinophilia were ruled out by routine and specific rheumatology laboratory examination, thyroid function test, serum vitamin B12 and IgE level, search for parasites, immunodeficiency state, bone marrow aspiration and biopsy, and cytogenetic study. Chest computed tomography (CT) scan and echocardiography showed lung and cardiac involvement. After treatment with a corticosteroid, she was in remission.During this admission she was afebrile but had tachycardia (120 b.p.m.). There were vesicular lesions on the pulp of her fingers and toes, and hyperpigmentation of skin folds (Panel A). Laboratory tests revealed marked leukocytosis (22.9 × 103/μL) with 40% eosinophils (9.16 × 103/μL). High-sensitive troponin level was high and showed an increase throughout the hospital course. Reverse transcription–polymerase chain reaction (RT–PCR) of a nasopharyngeal swab for new coronavirus was positive. Electrocardiography (ECG) showed sinus tachycardia and a Q wave in V1–V4 (Panel B). Echocardiography revealed moderate left ventricular (LV) systolic dysfunction and increased wall thickness (Panel C). Chest CT showed a bilateral ground-glass pattern. Cardiac magnetic resonance imaging (CMR) performed during hospitalization showed myocardial inflammation and oedema in the mid and apical anteroseptal wall with pericardial effusion (Panel D). She was treated with colchicine, naproxen, and a methylprednisolone pulse followed by oral prednisolone. Her symptoms were relieved and the blood eosinophil count decreased to 1.8 × 103/μL and LV systolic function normalized in follow-up.Panel A: papulovesicular lesions on the 2nd and 5th toes (arrows). Panel B: ECG shows sinus tachycardia, a Q wave in V1–V4, and T wave inversion in V4–V6. Panel C: parasternal short-axis view of echocardiography demonstrated a hypertrophied left ventricle. Panel D: CMR shows myocardial inflammation and oedema in the mid to apical anteroseptal wall (arrow).Conflict of interest: The authors have submitted their declaration which can be found in the article Supplementary Material online.Click here for additional data file.