{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T20:42:33Z","timestamp":1769114553107,"version":"3.49.0"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,9,9]],"date-time":"2021-09-09T00:00:00Z","timestamp":1631145600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p>Multisystem Inflammatory Syndrome (MIS) is a novel hyperinflammatory syndrome associated with SARS-CoV-2 infection. It predominantly affects children (MIS-C) a few weeks after a usually asymptomatic SARS-CoV-2 infection and is only rarely seen in adults above 21 years (MIS-A). Only scarce data on histological findings in both pediatric and adult patients has been published so far. An 18-year-old male patient was admitted to hospital in a febrile state, which progressed to severe cardiogenic shock and multi-organ failure requiring extracorporeal life support. Myocardial biopsy revealed small vessel-associated immune cell infiltrates. Diagnosis of MIS-C was made after ruling out all potential differential diagnosis. Use of immunosuppressive treatment with steroids, interleukin-1 blockade and high-dose intravenous immunoglobulins resulted in the patient's full recovery. Multisystem Inflammatory Syndrome (MIS) is a new differential diagnosis of cardiac dysfunction in pediatric and adult patients. The lack of myocardial necrosis differentiates the disease from other viral myocarditis and offers an explanation for the fast response to immunomodulatory therapy and the favorable prognosis. The preceding SARS-CoV-2 infection might only have been mildly symptomatic or even asymptomatic.<\/jats:p>","DOI":"10.3389\/fcvm.2021.716198","type":"journal-article","created":{"date-parts":[[2021,9,9]],"date-time":"2021-09-09T07:52:53Z","timestamp":1631173973000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":18,"title":["Case Report: Lymphohistiocytic Myocarditis With Severe Cardiogenic Shock Requiring Mechanical Cardiocirculatory Support in Multisystem Inflammatory Syndrome Following SARS-CoV-2 Infection"],"prefix":"10.3389","volume":"8","author":[{"given":"Xavier","family":"Bemtgen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karin","family":"Klingel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Markus","family":"Hufnagel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ales","family":"Janda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Bode","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dawid L.","family":"Staudacher","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Supady","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ilona","family":"Jandova","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,9,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"108634","DOI":"10.1016\/j.clim.2020.108634","article-title":"COVID-19: a review of therapeutic strategies and vaccine candidates","volume":"222","author":"Izda","year":"2021","journal-title":"Clin Immunol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"982","DOI":"10.1016\/j.cell.2020.09.034","article-title":"Mapping systemic inflammation and antibody responses in multisystem inflammatory syndrome in children (MIS-C)","volume":"183","author":"Gruber","year":"2020","journal-title":"Cell"},{"key":"B3","doi-asserted-by":"publisher","first-page":"41616","DOI":"10.1002\/art.41616","article-title":"American College of rheumatology clinical guidance for multisystem inflammatory syndrome in children associated with SARS\u2013CoV-2 and hyperinflammation in pediatric COVID-19: version 2","volume":"73","author":"Henderson","year":"2021","journal-title":"Arthritis Rheumatol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1607","DOI":"10.1016\/S0140-6736(20)31094-1","article-title":"Hyperinflammatory shock in children during COVID-19 pandemic","volume":"395","author":"Riphagen","year":"2020","journal-title":"Lancet"},{"key":"B5","doi-asserted-by":"publisher","first-page":"m2094","DOI":"10.1136\/bmj.m2094","article-title":"Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study","volume":"369","author":"Toubiana","year":"2020","journal-title":"BMJ"},{"key":"B6","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1056\/NEJMoa2021680","article-title":"Multisystem inflammatory syndrome in U.S. children and adolescents","volume":"383","author":"Feldstein","year":"2020","journal-title":"N Engl J Med"},{"key":"B7","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1001\/jama.2020.10369","article-title":"Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2","volume":"324","author":"Whittaker","year":"2020","journal-title":"J Am Med Assoc"},{"key":"B8","doi-asserted-by":"publisher","first-page":"40e1","DOI":"10.15585\/mmwr.mm6940e1","article-title":"Case series of multisystem inflammatory syndrome in adults associated with SARS-CoV-2 infection \u2014 United Kingdom and United States, March\u2013August 2020","volume":"69","author":"Morris","year":"2020","journal-title":"Morb Mortal Wkly Rep."},{"key":"B9","doi-asserted-by":"publisher","first-page":"993","DOI":"10.1007\/s00296-021-04843-1","article-title":"Multiple system inflammatory syndrome associated with SARS-CoV-2 infection in an adult and an adolescent","volume":"41","author":"Bastug","year":"2021","journal-title":"Rheumatol Int"},{"key":"B10","doi-asserted-by":"publisher","first-page":"911","DOI":"10.1002\/ejhf.1828","article-title":"Myocardial localization of coronavirus in COVID-19 cardiogenic shock","volume":"22","author":"Tavazzi","year":"2020","journal-title":"Eur J Heart Fail"},{"key":"B11","doi-asserted-by":"publisher","first-page":"2440","DOI":"10.1002\/ehf2.12805","article-title":"Detection of viral SARS-CoV-2 genomes and histopathological changes in endomyocardial biopsies","volume":"7","author":"Escher","year":"2020","journal-title":"ESC Heart Fail"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1661","DOI":"10.1093\/cvr\/cvaa160","article-title":"Evidence of SARS-CoV-2 mRNA in endomyocardial biopsies of patients with clinically suspected myocarditis tested negative for COVID-19 in nasopharyngeal swab","volume":"116","author":"Wenzel","year":"2020","journal-title":"Cardiovasc Res"},{"key":"B13","doi-asserted-by":"publisher","first-page":"268","DOI":"10.7326\/L20-1206","article-title":"Autopsy findings and venous thromboembolism in patients with COVID-19: a prospective cohort study","volume":"173","author":"Wichmann","year":"2020","journal-title":"Ann Intern Med"},{"key":"B14","doi-asserted-by":"publisher","first-page":"21","DOI":"10.2139\/ssrn.3634853","article-title":"Acute cardiovascular manifestations in 286 children with multisystem inflammatory syndrome associated with COVID-19 infection in Europe","volume":"143","author":"Valverde","year":"2021","journal-title":"Circulation"},{"key":"B15","doi-asserted-by":"publisher","first-page":"3827","DOI":"10.1093\/eurheartj\/ehaa664","article-title":"Pathological features of COVID-19-associated myocardial injury: a multicentre cardiovascular pathology study","volume":"41","author":"Basso","year":"2020","journal-title":"Eur Heart J"},{"key":"B16","doi-asserted-by":"publisher","first-page":"2207","DOI":"10.1093\/cvr\/cvaa267","article-title":"SARS-CoV-2 infects and induces cytotoxic effects in human cardiomyocytes","volume":"116","author":"Bojkova","year":"2020","journal-title":"Cardiovasc Res"},{"key":"B17","doi-asserted-by":"publisher","first-page":"2401","DOI":"10.1093\/eurheartj\/ehab269","article-title":"Lethal enterovirus myocarditis in a patient with granulomatosis with polyangiitis following rituximab and high-dose steroid therapy","volume":"42","author":"Klingel","year":"2021","journal-title":"Eur Heart J"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1281","DOI":"10.1001\/jamacardio.2020.3551","article-title":"Association of cardiac infection with SARS-CoV-2 in confirmed COVID-19 autopsy cases","volume":"5","author":"Lindner","year":"2020","journal-title":"J Am Med Assoc Cardiol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"8664","DOI":"10.1055\/a-1539-8664","article-title":"COVID-19 and myocarditis: findings from cardiac magnetic resonance imaging and endomyocardial biopsies","volume":"14","author":"Greulich","year":"2021","journal-title":"Hamostaseologie"},{"key":"B20","doi-asserted-by":"publisher","first-page":"e32","DOI":"10.1016\/S2213-2600(21)00085-0","article-title":"Delayed-onset myocarditis following COVID-19","volume":"9","author":"Bajaj","year":"2021","journal-title":"Lancet Respir Med"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2021.716198\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,9]],"date-time":"2021-09-09T07:52:55Z","timestamp":1631173975000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2021.716198\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,9]]},"references-count":20,"alternative-id":["10.3389\/fcvm.2021.716198"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2021.716198","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,9]]},"article-number":"716198"}}