COVID-19 Related Myocarditis and Stroke in Children: Spared but not Safe

Raj Sahulee
Department Of Pediatrics, Division Of Cardiology, NYU Grossman School Of Medicine, NY 10016, New York, United States

Published on: 2021-03-01

Abstract

Beginning in Wuhan China in 2019, the SARS-CoV-2 infection, or COVID-19, has spread to become a devastating worldwide pandemic. Myocarditis and stroke are known direct and indirect complications of SARS-CoV-2 infection. There is a growing body of literature describing the incidence of myocarditis and stroke in adults with COVID-19 related illness, and therapies to mitigate or prevent these catastrophic complications. In children, only a small number of case reports, case series, and expert consensus statements have been published regarding these aspects of COVID-19 related conditions. The incidence of these serious complications appears to be less frequent and less fatal compared to the adult population, yet fatal outcomes from both myocarditis and stroke have been reported in infants and children. Although rare events, I hope to briefly summarize what is known about COVID-19 related myocarditis and stroke in children for this commentary in the International Journal of Integrative Cardiology.

Keywords

COVID-19; MIS-C; PIMS-TS; Stroke; Myocarditis; Thromboembolism

Introduction

Beginning in Wuhan China in 2019, the SARS-CoV-2 infection, or COVID-19 has spread to become a devastating worldwide pandemic with over 104 million cases and 2.2 million deaths at the time of this report [1]. The acute and delayed multisystem effects of this virus are beginning to be more comprehensively described in the literature, however predominantly in adult patients. Fortunately, although millions of children have tested positive for COVID-19 to date, the mortality rate for children (0.01%) appears to be considerably less than that of adults (1.7%) [2]. However, children are not entirely spared from the serious and fatal effects of COVID-19. Many reports have described respiratory failure, myocarditis, and stroke in children with COVID-19. In September 2020 we published a case report entitled “Arterial ischemic stroke as an unusual first manifestation of parvovirus B19 myocarditis in an infant” [3]. At the time of this review, there has not been a report of a child with COVID-19 related myocarditis presenting with a cardioembolic stroke. However, for this commentary in the International Journal of Integrative Cardiology, I hope to briefly summarize what has been published about COVID-19 and myocarditis or stroke in children, highlight key studies (Table 1), and offer suggestions for areas for future investigation.

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