Zhang Y, Xiao M, Zhang S, et al. reaching 10.6%. 1 COVID\19 may indeed possess cardiac complications, including myocarditis, 2 and up to 31% of children possess myocardial enzyme elevation, mainly creatine kinase MB, despite no specific sign or sign of medical cardiac disease. Nevertheless, correlation between D\dimer and myocardial enzymes elevation (particularly creatine kinase MB) and disease severity has been explained. 3 No specific morphological and practical cardiac assessment offers yet been performed in COVID\19 children with elevated myocardial enzymes. For the first time, we statement the case of an infant affected by COVID\19 with recorded slight cardiac involvement. A full term, method\fed, 38\day old male presenting with slight fever (37.6C), rhinitis and moderate hyporeactivity was admitted about 27th March for clinical evaluation. The pregnancy had been unremarkable, and the mother had been vaccinated against influenza. Both parents were diagnosed with COVID\19 CGS 21680 HCl and household contagion was presumed. History was normally irrelevant CGS 21680 HCl and the infant did not display any sign or sign of acute respiratory stress. A full workup was performed. Total blood count showed fluctuations during the hospital stay, but lymphocytopenia was by no means observed (min,?7100/L); slight thrombocytosis (maximum,?525?000?/L) was present, with normal ideals of hemoglobin. C\reactive protein and erythrocyte sedimentation rate were confirmed bad throughout the hospital stay, while a prolonged increase in procalcitonin levels was observed (maximum, 3.28?ng/mL;?nv? ?0.5). Electrolytes were in normal range and lactate dehydrogenase was mildly improved. Liver transaminases were normal. Nasal and pharyngeal swab specimens tested positive for severe acute respiratory syndrome coronavirus 2 (SARS\CoV\2) nucleic acid by using actual\time reverse\transcriptase polymerase chain reaction assay on 28th March, while Allplex Seegene Respiratory Panel CGS 21680 HCl for 18 viruses resulted negative. Blood culture, urine tradition, and pharyngeal swab for S. pyogenes were also negative. Chest X\ray showed slight thickening of bronchovascular markings, but no pulmonary parenchymal opacities. The chest computed tomograpghy scan was not performed, thus avoiding the exposure to ionizing radiations in an infant without overt respiratory involvement. An increase in troponin T was observed (maximum, 8.2?ng/dL; research range for age 5), as well as a slightly elevated creatine kinase\MB (max, 9.8?g/L; research range 4.8). 4 Pro\mind natriuretic peptide (208?pg/mL) was normal. INR and partial thromboplastin time were normal, while D\dimer was found to be improved (maximum, 13.3?g/mL, research range 0.87) in two consecutive measurements, and subsequent spontaneous resolution. Fibrinogen transiently diminished (1.28?g/L, nv? ?1.5) without associated platelet usage. A graphical representation of laboratory tests trends is definitely shown in Number?1. Open in a separate window Figure 1 Time course of relevant cardiac and vascular biomarkers. Maximum and minimum ideals are reported next to the corresponding symbol Continuous monitoring of vital parameters documented resting heart rate of 140/min, with peak frequency of 200/min. Serial electrocardiograms and a 24\hour Holter electrocardiogram confirmed only moderate sinus tachycardia CGS 21680 HCl and a first cardiac ultrasonography was normal (Physique?2, ECSCR panel A). A cardiac magnetic resonance was also performed with the feed and sleep approach, which excluded edema of the myocardium and showed a minimal amount of pericardial effusion (Physique S1). Open in a separate window Physique 2 A, Four chamber view of the heart taken during the first cardiological evaluation shows normal structure and dimensions of cardiac chambers, without pericardial effusion. B, Four chamber view of the heart four days after the previous one shows a 2 to 3 3?mm pericardial effusion in the lateral\posterior pericardial space (arrow) Three days after the first cardiac ultrasound, a new sonographic evaluation documented a 2?mm pericardial effusion which did not evolve during follow\up (Physique?2, panel B). The patient remained asymptomatic with normal vital parameters, thus no specific treatment was undertaken. Serological tests ruled out other common causes of viral myopericarditis (Coxsackie computer virus, echovirus, cytomegalovirus, and Epstein\Barr computer virus). In concern of the altered D\dimer and fibrinogen, and given the recent reports of SARS\CoV\2 associated coagulopathy and cerebral infarcts, 5 the infant underwent a brain MR angiography with the feed and sleep approach which resulted normal. Lupus\like anti coagulants, anti\nuclear, and anti\cardiolipin antibodies were undetectable..