Conclusion:
This is the first reported pediatric case of COVID-19 related
hyperinflammatory shock with cardiac dysfunction and associated focal
myocarditis, suspected based on elevated cardiac-injury-related
biomarkers, electrocardiographic and echocardiographic abnormalities,
and confirmed using CMRI. A high index of suspicion for myocardial
involvement should be maintained in children with COVID-19. Focal
myocarditis can be concomitantly seen in these pediatric patients who
present with hyperinflammatory syndrome related global cardiac
dysfunction. If logistically feasible, CMRI should be considered in
these pediatric patients as it may provide significant insights into
possible mechanisms of cardiovascular involvement and allow for improved
risk stratification.