Evidence of SARS-CoV-2-Specific T-Cell-Mediated Myocarditis in a MIS-A Case
Kevin M. Vannella, Cihan Oguz, Sydney R. Stein, Stefania Pittaluga, Esra Dikoglu, Arjun Kanwal, Sabrina Ramelli, Thomas Briese, Ling Su, Xiaolin Wu, Marcos J. Ramos-Benítez, Luis Perez Valencia, Ashley L. Babyak, Nu Ri, Joon‐Yong Chung, Kris Ylaya, Ronson J. Madathil, Kapil Saharia, Thomas M. Scalea, Quincy Tran, Daniel Herr, David E. Kleiner, Stephen M. Hewitt, Luigi D. Notarangelo, Alison Grazioli, Daniel S. Chertow
Abstract
A 26-year-old otherwise healthy man died of fulminant myocarditis. Nasopharyngeal specimens collected premortem tested negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Histopathological evaluation of the heart showed myocardial necrosis surrounded by cytotoxic T-cells and tissue-repair macrophages. Myocardial T-cell receptor (TCR) sequencing revealed hyper-dominant clones with highly similar sequences to TCRs that are specific for SARS-CoV-2 epitopes. SARS-CoV-2 RNA was detected in the gut, supporting a diagnosis of multisystem inflammatory syndrome in adults (MIS-A). Molecular targets of MIS-associated inflammation are not known. Our data indicate that SARS-CoV-2 antigens selected high-frequency T-cell clones that mediated fatal myocarditis.