AUTHOR=Vannella Kevin M. , Oguz Cihan , Stein Sydney R. , Pittaluga Stefania , Dikoglu Esra , Kanwal Arjun , Ramelli Sabrina C. , Briese Thomas , Su Ling , Wu Xiaolin , Ramos-Benitez Marcos J. , Perez-Valencia Luis J. , Babyak Ashley , Cha Nu Ri , Chung Joon-Yong , Ylaya Kris , Madathil Ronson J. , Saharia Kapil K. , Scalea Thomas M. , Tran Quincy K. , Herr Daniel L. , Kleiner David E. , Hewitt Stephen M. , Notarangelo Luigi D. , Grazioli Alison , Chertow Daniel S. 

TITLE=Evidence of SARS-CoV-2-Specific T-Cell-Mediated Myocarditis in a MIS-A Case

JOURNAL=Frontiers in Immunology

VOLUME=12

YEAR=2021

URL=https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2021.779026

DOI=10.3389/fimmu.2021.779026

ISSN=1664-3224

ABSTRACT=<p>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.</p>