A case report of long COVID-19 and chronic active myocarditis.

Background: Post-acute sequelae of SARS-CoV-2 infection (PASC), commonly known as 'Long COVID-19', are progressively emerging in the population. While it was clear from the pandemic outbreak that pre-existing cardiac conditions were exacerbated by the infection even after its resolution, little is known about the rare cases of Case summary: A 74-year-old man was admitted to the emergency department with SARS-CoV-2 bilateral interstitial pneumonia at the computed tomography scan. A few months after, he developed acute myocarditis that slowly led to progressive myocardial fibrosis, systolic dysfunction, and a pro-arrhythmic state. Furthermore, these manifestations were associated with growing 'mental dullness' and chronic psychophysical asthenia. The patient underwent two cardiac MRI over 3 years witnessing the worsening of cardiac involvement and started full pharmacological therapy for heart failure. We report here the initial presentation, medical care, and clinical course of this patient. Discussion: In SARS-CoV-2 patients, long COVID-19-related myocarditis is one of the more severe complications. A thorough multimodal evaluation of these patients should be conducted, as presentation symptoms can appear subtle or misleading. Early identification of a chronic process of myocardial damage is crucial to implement early therapeutic strategies and prevent the potential worsening of heart failure.