A UNIQUE CASE OF PURE ASYMPTOMATIC PERICARDITIS IN COVID-19

Abstract

TYPE: Case Report TOPIC: Cardiovascular Disease INTRODUCTION: Acute pericarditis in COVID-19 pneumonia (PNA) can present during PNA, after PNA, or even as the main presentation. Chest pain and EKG changes should raise suspicion for pericarditis and be immediately addressed. CASE PRESENTATION: A 43 y/o male with no relevant medical history, presented with respiratory symptoms 20 days with COVID RT-PCR positive 17 days before admission. He was admitted for COVID PNA due to persistent productive cough, increasing dyspnea and decreased exercise tolerance. No chest pain with normal vitals, sat 98% on RA but complained of orthopnea. Labs: Troponin negative x4, potassium 5.1, and D-dimer 2388. He was started on therapeutic enoxaparin and given sodium zirconium cyclosilicate. EKG: diffuse ST segment elevations across precordial leads and lead I with reciprocal ST segment depression in aVR. TTE: small pericardial effusion. This would indicate 2/4 pericarditis diagnosis criteria. CXR and CTPE: b/l patchy and scattered ground-glass opacities. Ibuprofen 600 mg was started; however, colchicine was not initiated. ST segment elevations improved and he was discharged with ibuprofen and apixaban without complications. DISCUSSION: There are few reports on patients who developed pericarditis and pericardial effusions with COVID-19 infection. Most have been associated with myocardial involvement with increasing troponin. Treatment is an on-going debate, but consensus is that corticosteroids and colchicine are safe. CONCLUSIONS: This is a unique case of COVID-19 PNA complicated with troponin negative pericarditis. DISCLOSURE: Nothing to declare. KEYWORD: covid pericarditis