A case report of pleural effusion in a COVID-19 patient with multiple comorbidities

Abstract

We report a case of coronavirus disease 2019 (COVID-19) infection in a patient with multiple comorbidities diabetes, hypertension, ischemic heart disease, and chronic liver disease. Although pleural effusion is rarely seen in COVID-19 infection, the presence of which should be interpreted carefully. In this case report, our patient presented with complaints of fever, cough, and dyspnea, and focused clinical examination revealed fullness in the left hemithorax compared to right; reduced chest movements in the left hemithorax and trachea deviated to the right; dullness in the left hemithorax and right infrascapular, infra-axillary, and mammary area; and absent breath sounds in areas where dullness was noted. A chest X-ray done revealed left massive pleural effusion with right mild pleural effusion and pleural fluid analysis on both sides revealed transudate picture; this was also similar to the ascitic fluid analysis that was done in this patient; at this point of time, a computed tomography of the thorax was done to rule out other causes of pleural effusion. Meanwhile, other laboratory investigations revealed evidence of liver cell failure showing hyperbilirubinemia, hypoalbuminemia, and deranged prothrombin time and international normalized ratio (INR) and imaging evidence of cirrhotic liver; the patient was treated accordingly. Therapeutic pleural tapping was done after INR normalized; the patient improved symptomatically. Pleural effusion although is a rare manifestation of COVID-19, the etiologies are varied, it is important for us to consider other possible comorbidities associated in a patient who is hospitalized for acute illness, in this case, the patient had multiple comorbidities such as diabetes, hypertension, ischemic heart disease, and chronic liver disease, and the cause for pleural effusion is attributed to decompensated chronic liver disease and ischemic heart disease. In this case, the acute infection has resulted in the decompensation of his preexisting chronic disease.