Case Report

Rare Manifestation of COVID-19 Resulting in Coronary Artery Vasculitis

Table 1

Comparison with the prior reported cases of coronary artery aneurysm related to COVID-19.

AuthorsDiakite et al. [4]Alao et al. [5]Shin et al. [6]Qavi et al.

Publication year202120222022Present case
RaceSub-Saharan AfricanPakistaniNot reported (case reported from Korea)African American
Age (years)/gender33/M35/M66/M59/F
Immunologic workupNegativeNoneNoneNegative
ESRDNoNoYesYes
Clinical presentationFever, dyspnea, chest pain, shockCentral chest pain radiating to left armChest painChest pain
ECGNo ST segment abnormalitiesInferior ST segment elevationNot reportedNo ST segment abnormalities
TroponinInitial troponin 13.2 ng/mL. No trend was reportedInitial troponin T 0.009 ng/mL. No trend reportedNot reportedInitial troponin I was 0.15 ng/mL, followed by 0.52 ng/mL and 0.63 ng/mL at two and eight hours, respectively
C-reactive protein150 mg/LNot reportedNormal57.8 mg/L
EchoLVEF 20% with global hypokinesiaNot reportedLVEF 40% with hypokinesia of the base to mid inferior wall and basal inferolateral wall and akinesia of the mid inferolateral wallLVEF 50-55%, new RWMA in the anterior, apical, and inferior walls
COVID-19 vaccination statusNot reportedNot reportedReceived first dose 4 weeks priorReceived booster two months prior
COVID19 symptoms/testingViral symptoms started six weeks prior to presentation. Testing showed +ve IgG but –ve PCRAsymptomatic/testing was +ve during the same admissionHospitalization with COVID-19 pneumonia 4 months priorAsymptomatic/testing showed both +ve PCR and +ve IgG
COVID19 pneumoniaNot reportedChest X-ray was normalNot reportedChest X-ray was normal
Coronary angiogramCoronary CT angiogram: multiple aneurysms involving the RCA, intraventricular artery, and LCXCoronary angiogram: large proximal RCA aneurysm (14.46 mm diameter) with occlusive thrombus. Medium-sized LCX aneurysmCoronary angiogram: proximal RCA aneurysm with a diameter of 8.6 mm. Multiple stenotic lesions in the RCA and LCXCoronary angiogram: aneurysmal left main artery ( mm), ostial LAD was subtotally occluded, LCX 90% eccentric ostial stenosis. Dominant RCA with 70-80% ostial stenosis
TreatmentMedical management with IVIG, prednisone, and aspirinClot removed with an aspiration catheter2v-CABG: SVG to RCA, SVG to OM1 along with aneurysmal suturing2v-CABG: LIMA to LAD, SVG to OM2
Patient outcomeAt 5-month follow-up, repeat coronary CT showed complete resolution of CAAAt 2-month follow-up, the patient had no cardiac complicationsAt 5-month follow-up, the patient has no cardiac complicationsAt one-year follow-up, patient was asymptomatic. However, nuclear stress test showed a new anterior myocardial wall defect

Abbreviations: LVEF: left ventricular ejection fraction; IgG: immunoglobulin G; PCR: polymerase chain reaction; RWMA: regional wall motion abnormality; CT: computer tomography; RCA: right coronary artery; LCX: left circumflex artery; LAD: left anterior descending artery; OM: obtuse marginal; CABG: coronary artery bypass grafting; SVG: saphenous vein graft; CAA: coronary artery aneurysm; IVIG: intravenous immunoglobulin.