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The authors have not convinced me that coronavirus is the etiology in this case. Was there a family history of genetic disease, was the patient a present or former cocaine user, was there exposure to other chemicals? What were the results of a full liver profile, hepatitis screening, HIV screening, blood cultures and rheumatological testing? Should he have had a myocardial biopsy?
In addition to SARS-COV-2, other infectious agents to consider include viruses such as coxsackie, adenovirus, chlamydia, CMV, enteroviruses, influenza, parainfluenza, RSV and rhinovirus, bordetella and Lyme disease. Were these tested for?
The authors state “…. as evidenced by negative nasopharyngeal swabs and positive IgG antibodies, it is likely that this patient had SARS-CoV-2 infection “. As noted, he had no symptoms of infection with coronavirus. My concern is that there are other potential causes of his disease that do not seem to have been excluded. Tunnel vision is something we should try and avoid.
Competing Interests: None declared.References
- Shubham Agarwal, Haitham Al Hashimi, Sanjeev Kumar Agarwal, et al. Possible association between myocardial infarction with nonobstructed coronary arteries and SARS-CoV-2 infection. CMAJ 2020;192:E1633-E1636.