Title : Molnupiravir and Covid 19 myopericarditis: An indirect therapeutic role?
Abstract:
COVID-19 disease is associated with the emerging RNA virus, called SARS-CoV-2, which belongs to the Coronaviridae family, ubiquitous respiratory viruses among humans and mammals. A positive diagnosis is obtained through Reverse Transcription Polymerase Chain Reaction (RT-PCR) from a respiratory sample. While early data suggested a purely respiratory infection, more recent publications highlight the considerable pleomorphism of the disease, leading to multi-organ involvement, with cardiac involvement being the most prominent. Our clinical case illustrates a myopericarditis secondary to SARS-CoV-2 that evolved well under molnupiravir.
We report the clinical case of a 31-year-old young athlete, with no significant medical history, unvaccinated against SARS-CoV-2, with no toxic habits or medication use, admitted for an etiological workup of myopericarditis diagnosed by cardiac MRI. The condition presented clinically with acute chest pain mimicking acute coronary syndrome and dyspnea, preceded two days earlier by a flu-like syndrome. Given the pandemic context, a RT-PCR test for SARS-CoV-2 from a nasal swab returned positive. Additionally, other viral serologies were negative. Considering a potential autoimmune origin, we performed screening for antinuclear antibodies (ANA), which was negative. Antineutrophil cytoplasmic antibodies (ANCA) were also negative, with no signs suggestive of Behçet’s disease. We initiated antiviral treatment with Molnupiravir, 800 mg/day for 5 days, with good progress as assessed by normal echocardiography (no dilated cardiomyopathy) and cardiac MRI.
Data on the use of Molnupiravir in SARS-CoV-2-related myopericarditis remain limited. According to guidelines, this antiviral may be used in patients at risk for severe COVID-19 to reduce the viral load and, consequently, indirectly limit inflammation. However, in our clinical case, the role of Molnupiravir in the favorable outcome of cardiac involvement remains hypothetical, considering that viral myopericarditis often spontaneously resolves. Nevertheless, further studies should be considered to confirm the direct beneficial effect on myopericarditis.
