A Delayed Case of Pericarditis Following Recovery From COVID-19 Infection

Ann Kaminski,Michael Mohseni,Michael F Harrison,Michael Albus,Haares Mirzan

doi:10.7759/cureus.14397

Abstract

Pericarditis is a rare cardiac complication of coronavirus 19 (COVID-19) infection. Recent case reports describe severe sequelae of pericarditis, including cardiac tamponade, developing within days of initial COVID-19 symptoms. We present a case of pericarditis with slower onset and milder symptoms, developing over a period of a few weeks in an immunocompetent male who recovered from COVID-19 several months earlier.A 65-year-old male presented to an emergency department several times for one week of worsening chest and neck symptoms, along with fever. He had been symptom-free after a three-day course of cough, myalgias, and fever with positive COVID-19 testing, approximately 70 days earlier. He was ultimately admitted for fever and pericarditis with an associated pericardial effusion and positive PCR testing for COVID-19.Pericarditis should be considered in the differential diagnosis for patients with COVID-19 and unexplained persistent chest symptoms. The possibility of recurrent or atypical latent infection should additionally be considered in the months following the initial COVID-19 infection. Bedside ultrasound may facilitate early diagnosis and management of COVID-19 associated pericarditis.

Highlights

The first case of severe acute respiratory syndrome coronavirus (SARS-CoV-2), commonly referred to as coronavirus 19 (COVID-19), was diagnosed in China in late 2019 [1]
The mortality rates associated with COVID-19 infection are difficult to calculate with a high degree of accuracy due to uncertainty about the magnitude of the denominator [4,5]
Pericarditis and myocarditis presentations associated with positive COVID-19 PCR testing have ranged in reported acuity from mild symptoms to lethal tamponade

Summary

Introduction

The first case of severe acute respiratory syndrome coronavirus (SARS-CoV-2), commonly referred to as coronavirus 19 (COVID-19), was diagnosed in China in late 2019 [1]. He was not tested for COVID-19 during this visit He first presented to our ED two days later with a fever of 38.3 oC, persistent pleuritic chest pain, right posterior shoulder pain, and positional chest discomfort described as worse supine yet better sitting upright. His oxygen saturation during his ED visit remained 96% and above on room air He was discharged with a possible new diagnosis of COVID-19 versus persistent positive testing and recommendations for continued supportive care. A repeat chest x-ray demonstrated a new small left-sided pleural effusion (Figure 1) His labs were notable for a white blood cell count of 8.1 x 10 (9)/L, troponin T, fifth generation of 15 ng/L, elevated NT-pro BNP 331 pg/mL (normal ≤ 89 pg/mL), elevated D-dimer 6,178 ng/mL, and lactate 1.3 mmol/L. He was discharged home with 2.5 mg of apixaban twice daily for six weeks, based on institutional protocols for venous thromboembolism risk management in the setting of COVID-19 diagnosis, as well as a prednisone taper

Discussion

Conclusions

Disclosures

Fraser E