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Case Report | DOI: https://doi.org/10.31579/2690-1919/611
1University of Nicosia, GEMD program, 5th year
2Department of Cardiology, General Hospital of Limassol, Cyprus
*Equally contributed to this work
*Corresponding Author: Trogkanis Efstratios, Department of Cardiology, General Hospital of Limassol, Cyprus.
Citation: Koteich Aya, Rizk Liza, Tsymay Stephanie, Trogkanis Efstratios, (2026), From Covid-19 To Cardiogenic Shock: Fulminant Myocarditis Mimicking St-Elevation Myocardial Infarction, J Clinical Research and Reports, 23(3); DOI:10.31579/2690-1919/611
Copyright: © 2026, Trogkanis Efstratios. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 03 February 2026 | Accepted: 13 March 2026 | Published: 18 March 2026
Keywords: fulminant myocarditis; SARS-CoV-2; COVID-19; cardiogenic shock, ST-elevation myocardial infarction; echocardiography; Impella; mechanical circulatory support
Fulminant myocarditis can present with electrocardiographic features that mimic ST-elevation myocardial infarction (STEMI), posing diagnostic challenges. We report a case emphasizing the importance of systematic assessment prior to invasive intervention. A 29-year-old woman with no prior medical history developed cardiogenic shock five days post SARS-CoV-2 infection. Initial ECG revealed ST-elevation with left bundle branch block morphology and wide-complex tachycardia, initially suggestive of left anterior descending artery occlusion. However, transthoracic echocardiography demonstrated diffuse hypokinesia with preserved apical function, inconsistent with coronary distribution. The levels of cardiac biomarkers serially declined, therefore supporting an inflammatory process over ischemia. The medical team deferred catheterization, prioritizing hemodynamic stabilization with inotropic therapy and Impella support. Coronary angiography on day two revealed patent vessels. The left ventricular ejection fraction rapidly recovered from 20-25% to 60-65% within five days. Impella removal was complicated by femoral artery dissection requiring vascular surgery. This case demonstrates that ECG-echo discordance, preserved apical function despite anterior ST-elevation, and falling biomarkers should raise suspicion for fulminant myocarditis over acute coronary syndrome. Deferring catheterization until hemodynamic optimization may reduce iatrogenic risk while early mechanical support facilitates rapid myocardial recovery.
Fulminant myocarditis (FM) is a rare subgroup of acute myocarditis characterized by the sudden onset of severe, diffuse cardiac inflammation. This is a rapidly progressive syndrome that often leads to fatal outcomes due to cardiogenic shock, ventricular arrhythmias, or multi-organ system failure [1]. Clinically, it can be recognized by an acute symptom onset of less than two weeks and hemodynamic instability warranting inotropic therapy or temporary mechanical circulatory support (MCS) in the absence of other causes [2]. Although epidemiological data specific to FM is limited, it is estimated that between 5-10% of patients admitted with acute myocarditis present with a fulminant clinical picture [1]. Additionally, data suggests that the rate of FM is higher in males, and that higher mortality rates are observed in the younger population (<44>
Here, we report a case of a 29-year-old woman presenting with fulminant myocarditis.
A 29-year-old woman without prior, significant medical history presented to the Accident and Emergency Department with acute onset of hemodynamic instability preceded by five days of viral prodromal symptoms of cough, fever, sore throat, and headache. Three days before admission the patient developed gastrointestinal symptoms including nausea, diarrhea, and vomiting, followed by acute retrosternal chest pain lasting for 30 minutes on the morning of presentation. Furthermore, the patient experienced a syncopal episode at home approximately 24 hours prior to first visit. Following admission, a SARS-CoV-2 nasopharyngeal rapid test returned positive, consistent with SARS-CoV-2 infection. On presentation, the patient was hemodynamically unstable with a blood pressure of 75/45 mmHg, heart rate of 100 bpm, oxygen saturation of 95% and cool extremities. Upon initial presentation the patient was classified as Forrester Class C. The Forrester classification grades cardiogenic shock based on systemic perfusion and pulmonary congestion [7]. Class C is characterized as hypoperfusion in the absence of pulmonary congestion, often referred to as “cold and dry” shock [7]. The 12-lead electrocardiogram (ECG) initially demonstrated complex and vague findings that complicated the differential diagnosis. It revealed a wide-complex tachycardia at 100 bpm, with a broad QRS complex and undetermined basic rhythm as seen in Figure 1. Specifically, a left bundle branch block-like (LBBB) morphology was present along with atrioventricular (AV) dissociation. Changes were seen at the level of the ST-segments, particularly at the anteroventricular distribution (leads aVR, V1, and V2), along with reciprocal changes seen in the inferior leads (II, III, aVF). The P-wave was poorly visualized. The ECG pattern was highly suggestive of an acute left anterior descending (LAD) coronary artery STEMI. Following administration of intravenous amiodarone (50 mg over 5 minutes), the ventricular rate decreased from 100 to 50 bpm, with emergence of clearly visible P-waves dissociated from the QRS complexes, confirming underlying accelerated idioventricular rhythm (AIVR).
Figure 1: ECG on admission
The initial bedside transthoracic echocardiogram (TTE) revealed findings highly suggestive of diffuse myocardial inflammation rather than focal ischemia. It demonstrated a mildly dilated left ventricle along with a severely reduced left ventricular ejection fraction (LVEF) of 20-25%. Moreover, the patient's TTE demonstrated wall motion abnormalities that did not follow a distinct coronary artery pattern. She had akinetic segments in the basal and mid-wall regions, with all remaining segments being hypokinetic. However, the patient had preserved apical and anterior wall contraction. This finding is atypical for a LAD occlusion [7] and served as a diagnostic clue that helped to rule-out STEMI. The left ventricular outflow tract velocity time integral (LVOT VTI) was significantly reduced at 5.8 cm, indicating a reduced stroke volume consistent with cardiogenic shock. There was a mild degree of mitral and tricuspid regurgitation. The patient's right ventricular function was moderately reduced with a tricuspid annular plane systolic excursion (TAPSE) of 11mm, and no signs of pulmonary hypertension were observed. The pericardium was normal with no effusion noted. Serial troponin levels declined from 24 ng/L to 12 ng/L over 24 hours (reference range <14>
Initial fluid resuscitation involved administration of 500 mL of normal saline as a bolus to help restore intravascular volume. However, the patient failed to respond with only a slight improvement in her blood pressure from 75/45 to 90/60 mmHg. Given her persistent hypotension refractory to fluid resuscitation, the cardiology team initiated norepinephrine at a dose of 40 mg diluted in 250 mL of 5?xtrose at an infusion rate of 7-9 mL/hour. Despite this intervention, ongoing hypoperfusion and organ dysfunction were still present. Within 24 hours of admission, and despite receiving fluid resuscitation and pharmacological support, the patient deteriorated from Forrester Class C to Class D cardiogenic shock, which is defined as hypoperfusion with pulmonary congestion and multiorgan failure. This presented predominantly as acute kidney injury (AKI) with anuria, (urine output < 50ml>
Despite ECG findings suggestive of LAD-territory STEMI, the cardiology team deferred immediate coronary angiography and instead pursued maximal medical therapy followed by mechanical support. They opted for this approach due to the patient's young age and absence of underlying cardiac disease [7]. Moreover, the inconsistency between the ECG rhythm, biomarker pattern, and the TTE findings (diffuse dysfunction with preserved apical and anterior function) strongly suggested infective myocarditis over the initial diagnosis of STEMI. Therefore, the deferral for urgent coronary angiography was justified. However, it was pursued at a later stage to definitively exclude any findings suggestive of ischemia at the level of the coronary arteries. By 24 hours post-admission, the patient was still in a state of refractory shock. At this point in the patient’s management, mechanical support became essential. As the patient was deemed high-risk, angiography was coupled with Impella implantation (Figure 2A) to minimize complications. As anticipated, angiography revealed patent coronary arteries (Figures 2B and 2C).
Figure 2A: Impella in position Figure 2B: LAD and LCx view Figure 2C: RCA view
Orange arrow: Impella device inserted Blue arrow: patent coronary arteries
The Impella device was inserted via femoral artery access and provided support for five days. Repeat echocardiography demonstrated progressive recovery of ventricular function from 20–25% at presentation to 60–65% on day 5. Additionally, the ECG on day five showed resolution of ST-elevation and LBBB morphology with return to normal sinus rhythm. Hemodynamic stability was achieved with no further need for inotropic or vasopressor agents. Her stable condition justified Impella removal on day five, which was complicated by the development of right femoral artery dissection and subsequent limb ischemia. Immediate vascular surgery was scheduled to restore perfusion, with a successful final outcome.
The underlying pathophysiological mechanism of acute myocarditis consists of infection by a virus, activation of multiple immune pathways, and subsequent myopathy. Commonly implicated viruses include
parvovirus B19 and coxsackievirus, although recent research has identified a growing role for common respiratory viruses (i.e., coronaviruses) [1]. Viral-like symptoms typically appear several days prior to the onset of myocarditis. Immune activation is driven by virus-specific T lymphocytes generated by the host, which actively target and destroy myocardial tissue due to molecular mimicry [1]. This phase typically lasts from days to weeks. Dysregulated immune response and cytokine storm play key roles in the development of fulminant myocarditis. One study identified a significant upregulation in specific cytokines, such as IL-1b, IL-4, IL-17B, IL-23, and IL-10, among others [7]. This cytokine overproduction directly affects myocardial contraction and electrical transduction. Characteristic changes include ventricular wall hypokinesia, edema, and attenuated contractility [7]. In the case of myocarditis stemming from SARS-CoV-2 infection, it is proposed that direct injury to cardiomyocytes occurs due to binding of the virus to angiotensin converting enzyme 2 (ACE-2) receptors [8]. SARS-CoV-2 infection-related acute myocarditis has been characterized in the literature as causing sudden-onset cardiac dysfunction leading to cardiogenic shock, as in our case, and fatal arrhythmias. Such cases have been reported since the viral outbreak in 2020, with some cases specifically reported post-vaccination. Fulminant myocarditis related to SARS-CoV-2 is rare, with only 108 cases reported during the peak of the pandemic between 2020 and 2022 [8]. The reported cases showed male predominance, with a male to female ratio of approximately 1.5 and a mean age of 35-years-old [8]. Majority of patients presented with a comparable clinical picture characterized by fever, dyspnea, cough, increased heart rate, low blood pressure, and reduced left ventricular ejection fraction. Moreover, it has been reported that COVID-19 infection can also precipitate STEMI. Various pathophysiological mechanisms have been implicated, including inflammatory, thrombotic, and endothelial processes that augment plaque vulnerability and interfere with coronary flow [11]. This state of increased inflammation triggers cytokine release, resulting in a hypercoagulable state through the upregulation of tissue factors and activated platelets [11]. The hypercoagulable state increases the burden of thrombus formation and subsequent thrombus mobilization during PCI intervention [11]. Viral invasion of endothelial cells through ACE-2 receptors disrupts the renin-angiotensin system, increasing the endothelial dysfunction and risk of microvascular thrombosis. This can destabilize pre-existing atherosclerotic plaques and increase the probability of developing a type I MI [12,13]. This endothelial injury lingers beyond acute infection, with data demonstrating an approximate two-fold increase in MI incidence in the months following COVID-19 infection [12]. During the initial outbreak, cases of COVID-related STEMI resulted in increased rates of cardiogenic shock and mortality compared to non-infectious counterparts [14,15]. Some works of literature attribute these poorer outcomes to the delayed interval between initial symptoms and medical attention in COVID-19 related STEMI [14]. ECG is the diagnostic tool of choice for identifying STEMI in acute emergency settings. It provides a rapid and non-invasive assessment of the heart's electrical activity. In most cases, the ECG demonstrates high specificity for STEMI when showcasing ST- segment elevation in contiguous leads. However, sensitivity is more limited which can lead to the underdiagnosis of true STEMI episodes. Currently, the standard ECG has limited sensitivity of 30–70% and specificity of 70–100% [10]. In terms of FM, abnormalities seen on ECG include nonspecific ST-segment changes, and conduction disturbances [9]. As such, ECG accuracy is highest when interpreted alongside clinical presentation and compared with previous recordings, if available. It is important to note that fulminant myocarditis can mimic STEMI electrocardiographically without underlying coronary pathology, as demonstrated in our case. This generates diagnostic uncertainty as the ECG changes could refer to a true coronary occlusion or global myocardial inflammation producing a STEMI-like image [16]. For clarity, our patient received continuous ECG monitoring to aid in revealing any new dynamic ischemic changes suggestive of a myocardial infarction or point to an alternative diagnosis. To definitively exclude STEMI, the changes observed on ECG ought to be interpreted alongside cardiac biomarkers, echocardiography, and coronary angiography. Our case therefore emphasizes the importance of evaluating electrocardiographic trace in the context of other findings to better assess the likelihood of an ACS or non-ACS presentation. The ECG presentation of this case was misleading in the first instance, which impeded the final diagnosis of fulminant myocarditis. It is generally recognized that the ST-segment elevation associated with ACS is also present in myocarditis, therefore limiting the specificity of this finding [7,17]. ECG abnormalities characterized in myocarditis broadly include ST-segment elevation, T-wave inversion, QRS prolongation, AV block, along with various forms of arrhythmias [17]. Our patient's specific ST-segment elevation distribution, along with a newly detected LBBB, would typically prompt consideration of STEMI involving the LAD. Despite her ECG trace being strongly suggestive of ACS, subsequent TTE provided diagnostic clarity. In particular, the pattern of wall motion abnormality proved critical in terms of differential diagnosis. In acute cases of LAD occlusion, regional wall motion abnormality is expected to follow a coronary distribution consistent with the LAD territory, namely the anterior wall, anteroseptal wall, and apex [19]. The discrepancy between the ECG pattern (suggesting LAD involvement) and the TTE findings seen with our patient (showing preserved apex and anterior wall with basal dysfunction) was incompatible with ACS and coronary ischemia, instead suggesting diffuse myocardial inflammation characteristic of a myocarditis picture [18]. This case exemplifies the importance of the “ECG-echo mismatch” as part of the diagnostic pathway when aiming to differentiate true episodes of STEMI from mimics. The decision to defer immediate coronary angiography and instead opt for maximal medical optimization followed by catheterization was deliberate. This approach diverges from standard STEMI/ACS protocols which require immediate revascularization. However, this was justified by clinical considerations specific to myocarditis. This was the case for our patient who was suspected of having acute myocarditis complicated by hemodynamic instability. In the setting of cardiogenic shock with reduced systemic perfusion and anuria, renal clearance of iodinated contrast is markedly impaired, increasing the risk of contrast-induced nephrotoxicity through oxidative stress, vasoconstriction, and ischemic tubular injury [20,21]. Additionally, low cardiac output promotes venous stasis, leading to contrast pooling and layering on CT imaging [22]. These findings act as a marker for cardiogenic shock, which should be promptly recognized and treated to prevent further decompensation. Therefore, the use of contrast media solution should be carefully weighed due to the high risk of worsening renal injury and contrast retention. This was taken into consideration in the context of our patient who presented with cardiogenic shock and AKI. Evidently, performing coronary angiography in a critically ill patient with refractory cardiogenic shock comes with several complications and risks. The use of radiographic contrast is known to carry the potential to exacerbate AKI and heart failure. Moreover, all clinical interventions should revolve around the Hippocratic decree of “do no harm”. Deferring angiography until it was safe to do so and prioritizing the patient’s hemodynamic status allowed the cardiology team to uphold this pillar. Our case represents a complex “risk-benefit” scenario, demonstrating the importance of both timing and hemodynamic optimization in an acute clinical setting such as fulminant myocarditis. Initial supportive management is strongly advised in FM, which includes mechanical ventilation, inotropic agents, and vasopressors to correct hypotension or respiratory failure, and overt cardiogenic shock. Inotropic therapy is essential to achieve hemodynamic stability in shocked patients. Dobutamine is the most frequently used agent, followed by epinephrine and norepinephrine. However, high doses of inotropic agents in adult patients are avoided to prevent precipitating tachyarrhythmias [23]. Additional pharmacotherapy may involve immunosuppressive agents, particularly in patients presenting with eosinophilic and giant cell subtypes. If appropriate, they may be initiated once active viral infection is excluded on endomyocardial biopsy by PCR [1]. Current recommendations are to administer high-dose intravenous corticosteroids (1g methylprednisolone/daily) for a minimum of three days [23]. Plasmapheresis may also be used depending on the etiology of fulminant myocarditis. In critically ill patients with low cardiac output and reduced LVEF, it is recommended to consider mechanical circulatory support (MCS) devices for cardiorespiratory support. The purpose of temporary MCS in FM is to intervene prior to the development of multi-organ failure to reduce mortality. The benefits of MCS devices include reduced cardiac workload, improved coronary perfusion, immune response modulation, and creating an optimized environment for recovery [23]. Device selection should be tailored according to patient factors, severity of cardiogenic shock, and organ function. Extracorporeal life support, most often venoarterial extracorporeal membrane oxygenator (VA-ECMO), is considered one of the most efficient means of providing complete hemodynamic support in FM patients in the short-term. However, the consequential increase in afterload and left ventricular distention from VA-ECMO may require additional devices, such as an intra-aortic balloon pump, to support left ventricular unloading [23]. Combined ECMELLA therapy, consisting of VA-ECMO and Impella, is associated with reduced mortality as compared to VA-ECMO alone [23]. The Impella device is a percutaneous, catheter-mounted axial flow pump that directly unloads the left ventricle by aspirating blood from the left ventricular cavity and delivering it to the ascending aorta [7]. As such, it provides temporary MCS that directly assists the heart with its pumping function and maintains systemic perfusion to all organs. It is guided via fluoroscopy and inserted at the level of the aortic valve in the left ventricle through the femoral artery. The Impella device helps promote hemodynamic stability in patients experiencing cardiogenic shock, with severe coronary artery disease or during high-risk PCI [24]. Moreover, early Impella placement is associated with improved outcomes by reducing left ventricle myocardial oxygen consumption, end-diastolic compliance, and pulmonary capillary wedge pressure [25]. This rationale was applied in the case of our shocked patient who underwent Impella implantation during coronary angiography. When used as a bridge-to-recovery, duration of MCS is typically between 7-10 days due to the self-limited nature of FM. It is also important to note that Impella use has been associated with vascular complications such as bleeding. Our patient experienced access-site complication following removal of the Impella device. She developed a femoral artery dissection with thrombosis that required immediate surgical intervention. Several factors were reported to have contributed to the increased risk of femoral bleeding, such as the use of large-bore sheaths, increasing age, female sex, and antiplatelet drugs. Other complications include access site‐related infection, ischemic and hemorrhagic stroke, and myocardial infarction [24]. Additionally, implantable (ICD) and wearable (WCD) cardioverter-defibrillators may also play a role in secondary prevention following the development of arrhythmias. Current recommendations support the use of ICD in patients with non-active myocarditis for sustained tachyarrhythmias to prevent sudden cardiac death (SCD) [26]. Moreover, recent data regarding the use of WCD devices suggests that myocarditis patients at risk of developing ventricular tachyarrhythmia may benefit from their use, particularly in the setting of a left ventricular ejection fraction of less than 35% or prior occurrence of tachyarrhythmia [27]. Once patients with FM recover from cardiogenic shock and are hemodynamically stable, it is advised to start treatment for heart failure [9]. Pharmacological therapy includes beta-blockers, angiotensin-receptor/neprilysin inhibitors (ARNI), mineralocorticoid receptor antagonists (MRAs), SGLT2 inhibitors and diuretics [28]. In addition, continued immunosuppressive therapy may be considered for certain subtypes of myocarditis such as eosinophilic and giant cell myocarditis, particularly in the setting of systemic autoimmune disease [9]. Despite the severe clinical course of FM, a high long-term survival rate is reported with early, aggressive, and adequate treatment. Most patients regain near-complete or complete recovery of the left ventricular function within weeks or months. Moreover, recurrence of FM is uncommon, including COVID-19-associated cases. Some literature suggests that there is an 84% lower risk of reinfection in the next seven months following the primary infection [29]. Other studies reveal that a subset of patients who developed myocarditis as a result of SARS-CoV-2 infection may be more prone to developing a second episode after receiving a dose of COVID-19 vaccination [29]. When comparing the prognosis of acute and fulminant myocarditis, one study found that over 20% of FM patients developed heart failure, ventricular dilatation or arrhythmias as compared to approximately 10% of acute myocarditis patients [7].
Being a single case report, the observations described may not be generalizable to a wider patient population. Additionally, the diagnosis of fulminant myocarditis following COVID-19 infection was based on clinical presentation, ECG and TTE findings, and biomarker trends. It is important to note that endomyocardial biopsy, which is the gold standard for definitive diagnosis, was not performed in this case. Finally, follow-up data was limited, restricting evaluation of the patient’s long-term cardiac recovery and clinical outcomes.
The rapid clinical course of FM requires early recognition and precise interventions to optimize patient outcomes. A high index of suspicion for FM is warranted in young patients presenting with a clinical picture of acute heart failure unresponsive to initial resuscitation, as in our case. Pursuing the incorrect treatment pathway, such as for ACS, may cause unnecessary delays and significantly worsen prognosis. In terms of our patient, discrepancies across investigations enabled the medical team to promptly revise the likely diagnosis and adjust the management approach accordingly. Moreover, the correct timing of each intervention is crucial in minimizing iatrogenic errors and safeguarding patients whilst they undergo the diagnostic pathway. Additionally, the use of MCS devices, like Impella, play a key role in supporting shocked FM patients. This rationale was applied in the management of our patient, who underwent delayed coronary angiography supported by Impella implantation. This case reflects the importance of differentiating similar medical presentations and using clinical reasoning to identify if and when to switch protocols, bearing in mind patient safety.
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Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Matteo Bonori.
I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.
Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. It was truly a rewarding experience to work with the journal “Clinical Cardiology and Cardiovascular Interventions”. The peer review process was insightful and encouraging, helping us refine our work to a higher standard. The editorial office offered exceptional support with prompt and thoughtful communication. I highly value the journal’s role in promoting scientific advancement and am honored to be part of it. Best regards, Meng-Jou Lee, MD, Department of Anesthesiology, National Taiwan University Hospital.
Dear Editorial Team, Journal-Clinical Cardiology and Cardiovascular Interventions, “Publishing my article with Clinical Cardiology and Cardiovascular Interventions has been a highly positive experience. The peer-review process was rigorous yet supportive, offering valuable feedback that strengthened my work. The editorial team demonstrated exceptional professionalism, prompt communication, and a genuine commitment to maintaining the highest scientific standards. I am very pleased with the publication quality and proud to be associated with such a reputable journal.” Warm regards, Dr. Mahmoud Kamal Moustafa Ahmed
Dear Maria Emerson, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews’, I appreciate the opportunity to publish my article with your journal. The editorial office provided clear communication during the submission and review process, and I found the overall experience professional and constructive. Best regards, Elena Salvatore.
Dear Mayra Duenas, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews Herewith I confirm an optimal peer review process and a great support of the editorial office of the present journal
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. I am really grateful for the peers review; their feedback gave me the opportunity to reflect on the message and impact of my work and to ameliorate the article. The editors did a great job in addition by encouraging me to continue with the process of publishing.
Dear Cecilia Lilly, Editorial Coordinator, Endocrinology and Disorders, Thank you so much for your quick response regarding reviewing and all process till publishing our manuscript entitled: Prevalence of Pre-Diabetes and its Associated Risk Factors Among Nile College Students, Sudan. Best regards, Dr Mamoun Magzoub.
International Journal of Clinical Case Reports and Reviews is a high quality journal that has a clear and concise submission process. The peer review process was comprehensive and constructive. Support from the editorial office was excellent, since the administrative staff were responsive. The journal provides a fast and timely publication timeline.
Dear Maria Emerson, Editorial Coordinator of International Journal of Clinical Case Reports and Reviews, What distinguishes International Journal of Clinical Case Report and Review is not only the scientific rigor of its publications, but the intellectual climate in which research is evaluated. The submission process is refreshingly free of unnecessary formal barriers and bureaucratic rituals that often complicate academic publishing without adding real value. The peer-review system is demanding yet constructive, guided by genuine scientific dialogue rather than hierarchical or authoritarian attitudes. Reviewers act as collaborators in improving the manuscript, not as gatekeepers imposing arbitrary standards. This journal offers a rare balance: high methodological standards combined with a respectful, transparent, and supportive editorial approach. In an era where publishing can feel more burdensome than research itself, this platform restores the original purpose of peer review — to refine ideas, not to obstruct them Prof. Perlat Kapisyzi, FCCP PULMONOLOGIST AND THORACIC IMAGING.
Dear Grace Pierce, International Journal of Clinical Case Reports and Reviews I appreciate the opportunity to review for Auctore Journal, as the overall editorial process was smooth, transparent and professionally managed. This journal maintains high scientific standards and ensures timely communications with authors, which is truly commendable. I would like to express my special thanks to editor Grace Pierce for his constant guidance, promt responses, and supportive coordination throughout the review process. I am also greatful to Eleanor Bailey from the finance department for her clear communication and efficient handling of all administrative matters. Overall, my experience with Auctore Journal has been highly positive and rewarding. Best regards, Sabita sinha
Dear Mayra Duenas, Editorial Coordinator of the journal IJCCR, I write here a little on my experience as an author submitting to the International Journal of Clinical Case Reports and Reviews (IJCCR). This was my first submission to IJCCR and my manuscript was inherently an outsider’s effort. It attempted to broadly identify and then make some sense of life’s under-appreciated mysteries. I initially had responded to a request for possible submissions. I then contacted IJCCR with a tentative topic for a manuscript. They quickly got back with an approval for the submission, but with a particular requirement that it be medically relevant. I then put together a manuscript and submitted it. After the usual back-and-forth over forms and formality, the manuscript was sent off for reviews. Within 2 weeks I got back 4 reviews which were both helpful and also surprising. Surprising in that the topic was somewhat foreign to medical literature. My subsequent updates in response to the reviewer comments went smoothly and in short order I had a series of proofs to evaluate. All in all, the whole publication process seemed outstanding. It was both helpful in terms of the paper’s content and also in terms of its efficient and friendly communications. Thank you all very much. Sincerely, Ted Christopher, Rochester, NY.
Dear Grace Pierce, Editorial Coordinator of the journal IJCCR, I had a very positive experience with Auctores - Journal throughout the publication process. The Editorial Team was highly responsive, professional, and supportive at every stage. I would like to extend my sincere thanks to the Editor: Grace Pierce, for her guidance and assistance. The peer-review process was smooth and constructive, helping improve the quality of my work. I would gladly recommend Auctores Journal to fellow researchers and authors. Dr. SABITA SINHA, Medical Oncologist, MD (Electro Homeopathy).
