A study developed with the collaboration of professors, researchers and doctors from the departments of Pathology, Pediatrics (Institute of Children and Adolescents of Hospital das Clínicas) and Gastroenterology of the Faculdade de Medicina da Universidade de São Paulo (FMUSP), resulted in a publication in the scientific journal The Lancet Child & Adolescent Health, entitled “SARS-CoV-2 in cardiac tissue of a child with Covid-19-related multisystem inflammatory syndrome”, on August 20th, 2020.

In the case studied, a previously healthy adolescent patient developed a severe clinical picture of systemic inflammation, with persistent fever and abdominal pain, followed by respiratory distress and cardiac dysfunction, which evolved to a cardiogenic shock in a short period of 28 hours. Covid-19 was confirmed by the post-mortem nasal swab PCR test. A minimally invasive autopsy was performed, with a complementary study of the heart by electron microscopy.

“Microscopic analysis of the lungs showed a mild picture of Sars-Cov-2 pneumonia and the presence of pulmonary microthrombosis, found in a large number of patients with severe Covid-19. However, the most affected organ in this case was the heart, which showed significant inflammation (pancarditis), with necrosis and loss of cardiac fibers, which led to heart failure and death ”, said Professor Marisa Dolhnikoff of the Pathology Department at FMUSP and the main author of the study.

The severe systemic inflammatory condition in children and adolescents with probable association with SARS-Covid2/Covid-19 infection is currently called Multisystem Inflammatory Syndrome in Children (MIS-C), in portuguese Síndrome Inflamatória Multissistêmica Pediátrica (SIM-P). The initial objective of the research to determine if there is in fact a direct relationship between Sars-Cov-2 infection and the condition of  dysfunction and heart failure has been proven. Professor Marisa said that this is the first papper to show the presence of the virus in cardiac muscle cells of a patient with Covid-19.

"Although MIS-C is quite rare, with around 1,000 cases globally recorded since April, our findings come at a time when the scientific community around the world draws attention to the Syndrome and the need to be quickly recognized and treated The studies we know so far show that with hospitalization and treatment, most children with MIS-C have a favorable evolution and recovering, however, our study warns of the possibility of cardiac sequelae in these children, who will be followed up”, says Prof. Marisa Dolhnikoff.

Read the entirety study at:

Figure 1: corresponds to a section of the cardiac tissue seen under an optical microscope. Note the presence of interstitial inflammation and areas of cardiac muscle cell necrosis (asterisk).

Figure 2: it is an image obtained in the electron microscope, in great magnification, showing viral particles (arrows) in the cytoplasm of the cardiac muscle cell, neighboring the cellular nucleus (naked) and the contractile myofibrils (mf).