Letter to the editor Fulminant myocarditis and COVID-19

To the Editor,

We found the article titled “Fulminant myocarditis due to COVID-19” very interesting.¹ Irabien-Ortiz et al. report a COVID-19 patient and note that “the clinical picture was consistent with acute myocarditis, with no initial respiratory symptoms and with rapid clinical progression to cardiogenic shock and need for venoarterial ECMO support.”¹ We would like to share ideas on this clinical issue. There are some sporadic reports on this cardiac problem in COVID-19.^2,3 In our country, Thailand, the second country to experience COVID-19,⁴ there are still no patients with myocarditis due to COVID-19, although there are many severely ill patients and the infection has been in circulation for 4 months. An important clinical consideration is the pathophysiology of myocarditis in COVID-19. There may be direct viral invasion or the disease may be an immune disease.^2,3 Finally, there is a possibility that the patient reported by Irabien-Ortiz et al. may have had a concurrent medical disorder such as another viral infection that could have induced the myocarditis.