tetano
Editor, Senior Moderator
Am J Case Rep
. 2026 Mar 27:27:e951623.
doi: 10.12659/AJCR.951623.
Reverse Takotsubo Syndrome Triggered by COVID-19-Associated Cytokine Storm: Unveiling a Novel Pattern of Myocardial Dysfunction in SARS-CoV-2 Infection
Killen H Briones-Claudett[SUP] 1 2 [/SUP], Killen H Briones-Zamora[SUP] 3 [/SUP], Jaime Benites Solís[SUP] 2 4 [/SUP], María Antonieta Touriz Bonifaz[SUP] 5 6 [/SUP], Enny Berrus Zhumi[SUP] 2 [/SUP], Anahí D Briones-Zamora[SUP] 2 3 [/SUP], Diana C Briones Márquez[SUP] 2 4 [/SUP], Angela Germania Monserrate Romero[SUP] 5 [/SUP], Miguel Anderson Tayupanta Alban[SUP] 5 [/SUP], Hans Mautong[SUP] 7 [/SUP]
Affiliations
BACKGROUND Reverse takotsubo cardiomyopathy (rTTC) is a rare variant of stress-induced cardiomyopathy typically associated with neurological triggers. Recent evidence suggests that hyperinflammatory states, such as cytokine storm as seen in some COVID-19 cases, may precipitate rTTC. We present a unique case of rTTC occurring during SARS-CoV-2 infection with the omicron variant, highlighting diagnostic and therapeutic implications. CASE REPORT A 48-year-old Hispanic woman with morbid obesity, hypertension, and rheumatoid arthritis, fully vaccinated against COVID-19, presented with chest pain, fever, and respiratory symptoms. SARS-CoV-2 infection was confirmed by RT-PCR. Initial laboratory test results showed hyperferritinemia (peak: 14 707 ng/mL). On Day 4, cardiac biomarkers were elevated (troponin T: 28 ng/L; NT-proBNP: 1582 pg/mL). Transthoracic echocardiography revealed basal hypokinesia with preserved apical contractility and moderately reduced left ventricular ejection fraction (LVEF) (45%), consistent with reverse takotsubo cardiomyopathy. She received colchicine and spironolactone as anti-inflammatory therapy. Gradual clinical and echocardiographic improvement followed. At her 6-month follow-up, her LVEF had normalized to 63%, and she remained asymptomatic. No cardiac sequelae were detected at 12 months. CONCLUSIONS This case illustrates how COVID-19-associated cytokine storm can precipitate rTTC in the absence of obstructive coronary disease, even in vaccinated individuals. The temporal alignment between inflammatory marker peaks and left ventricular dysfunction supports a transient, inflammation-mediated myocardial stunning. Clinicians should consider rTTC in COVID-19 patients presenting with atypical chest pain and modest biomarker elevation. Early echocardiography and targeted anti-inflammatory therapy may facilitate diagnosis and promote full recovery.
. 2026 Mar 27:27:e951623.
doi: 10.12659/AJCR.951623.
Reverse Takotsubo Syndrome Triggered by COVID-19-Associated Cytokine Storm: Unveiling a Novel Pattern of Myocardial Dysfunction in SARS-CoV-2 Infection
Killen H Briones-Claudett[SUP] 1 2 [/SUP], Killen H Briones-Zamora[SUP] 3 [/SUP], Jaime Benites Solís[SUP] 2 4 [/SUP], María Antonieta Touriz Bonifaz[SUP] 5 6 [/SUP], Enny Berrus Zhumi[SUP] 2 [/SUP], Anahí D Briones-Zamora[SUP] 2 3 [/SUP], Diana C Briones Márquez[SUP] 2 4 [/SUP], Angela Germania Monserrate Romero[SUP] 5 [/SUP], Miguel Anderson Tayupanta Alban[SUP] 5 [/SUP], Hans Mautong[SUP] 7 [/SUP]
Affiliations
- PMID: 41889028
- DOI: 10.12659/AJCR.951623
BACKGROUND Reverse takotsubo cardiomyopathy (rTTC) is a rare variant of stress-induced cardiomyopathy typically associated with neurological triggers. Recent evidence suggests that hyperinflammatory states, such as cytokine storm as seen in some COVID-19 cases, may precipitate rTTC. We present a unique case of rTTC occurring during SARS-CoV-2 infection with the omicron variant, highlighting diagnostic and therapeutic implications. CASE REPORT A 48-year-old Hispanic woman with morbid obesity, hypertension, and rheumatoid arthritis, fully vaccinated against COVID-19, presented with chest pain, fever, and respiratory symptoms. SARS-CoV-2 infection was confirmed by RT-PCR. Initial laboratory test results showed hyperferritinemia (peak: 14 707 ng/mL). On Day 4, cardiac biomarkers were elevated (troponin T: 28 ng/L; NT-proBNP: 1582 pg/mL). Transthoracic echocardiography revealed basal hypokinesia with preserved apical contractility and moderately reduced left ventricular ejection fraction (LVEF) (45%), consistent with reverse takotsubo cardiomyopathy. She received colchicine and spironolactone as anti-inflammatory therapy. Gradual clinical and echocardiographic improvement followed. At her 6-month follow-up, her LVEF had normalized to 63%, and she remained asymptomatic. No cardiac sequelae were detected at 12 months. CONCLUSIONS This case illustrates how COVID-19-associated cytokine storm can precipitate rTTC in the absence of obstructive coronary disease, even in vaccinated individuals. The temporal alignment between inflammatory marker peaks and left ventricular dysfunction supports a transient, inflammation-mediated myocardial stunning. Clinicians should consider rTTC in COVID-19 patients presenting with atypical chest pain and modest biomarker elevation. Early echocardiography and targeted anti-inflammatory therapy may facilitate diagnosis and promote full recovery.