From COVID-19 to influenza A - recurrent viral myocarditis and successful immunosuppressive therapy: A case report and review of literature

Table 1 Summary of diagnostic features and therapeutic strategies in two episodes of fulminant viral myocarditis

	COVID-19 fulminant myocarditis (March-April 2023)	Influenza A myocarditis (January-February 2025)
Age	27	29
Triggering virus	SARS-CoV-2	Influenza A
Hemodynamic status at admission	Cardiogenic shock, VA-ECMO required	LVEF reduction, but no mechanical support needed
ICU support	Inotropes (noradrenaline, dobutamine, levosimendan); VA-ECMO (7 days)	Mechanical circulatory support not required; levosimendan administered
Immunosuppressive therapy	Methylprednisolone IV high dose (3 mg/kg/day for 3 days, then 1 mg/kg/day for one month, followed by tapering to 0.33 mg/kg/day)	Methylprednisolone IV high dose (3 mg/kg/day for 3 days, then 1 mg/kg/day for 2 weeks), then oral prednisone 1 mg/kg/day for 2 weeks, subsequently tapered to 25 mg/day
Antiviral therapy	Intravenous remdesivir	Oral oseltamivir
Other immunomodulators	Monoclonal anti-SARS-CoV-2 antibodies (500 mg IV)	None
Other key therapies	Bisoprolol 5 mg/day	Bisoprolol 2.5 mg/day
Outcome at discharge	Asymptomatic, LVEF 60%, scheduled follow-up and CMR	Asymptomatic, LVEF 60%, scheduled follow-up and CMR
Follow-up	Cardiology clinic, CMR at 6 months, lab tests	Cardiology clinic, CMR at 6 months, lab tests, genetic screening
Therapy at 6 months	Discontinuation of corticosteroids at 3 months and bisoprolol at 6 months	Continuation of low-dose prednisone (5 mg/day) and bisoprolol (2.5 mg/day)

COVID-19: Coronavirus disease 2019; SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2; VA-ECMO: Veno-arterial extracorporeal membrane oxygenation; LVEF: Left ventricular ejection fraction; CMR: Cardiac magnetic resonance.