COVID-19 Associated Acute Viral Myocarditis and Thyroid Gland Follicular Neoplasm in a Hemodialysis Patient

Since the first cases were reported in Wuhan, China, COVID-19 has spread swiftly worldwide and is caused by SARS-CoV-2. The development of myocardial injury is associated with significantly worse clinical course and increased mortality. However, currently, it is unclear whether cardiac injury occurred in COVID-19 patients. Histological results obtained directly from the viral infection of the myocardium (i.e., SARS-CoV-2 viral myocarditis) or indirectly from the complications of COVID-19, showed that only a portion of patients infected with the virus developed viral myocarditis. Therefore, it is possible that with more autopsy evidence of SARS-CoV-2 and more correlation with the severity of the viral infection, viral myocarditis will emerge. Although COVID-19 manifests primarily as respiratory disease, few cases of cardiac injury without respiratory involvement or febrile illness have been reported. The pathogenesis of cancer and viral infections is due to the inability of the immune system to distinguish between self and non-self. Several oncogenic (hepatitis B virus, hepatitis C virus, human papilloma virus, Epstein-Barr virus, and HIV) and oncolytic viruses (coxsackievirus, reovirus, vaccinia virus, and adenovirus) are known to cause and regress various cancer types. We report a case of atypical manifestation of COVID-19-induced acute myocarditis and thyroid gland follicular neoplasm in a hemodialysis patient with no respiratory symptoms. This case illustrates that COVID-19 can present atypically and affect non-respiratory organ systems.