Abstract
Severe acute respiratory syndrome coronavirus (SARS-CoV-2) emerged from Wuhan, China, in 2019, causing coronavirus disease 19 (COVID-19) and creating a global pandemic affecting millions of people worldwide. Though COVID-19 primarily affects the pulmonary structures, deleterious effects can also occur in the cardiac system. We present a case of a patient with recurrent pericardial effusions secondary to COVID-19 infection, an unusual cardiovascular manifestation of this disease. A 47-year-old man presented with altered mental status and tested positive for COVID-19. He left against medical advice and later presented two weeks later with pleuritic chest pain associated with shortness of breath. His symptoms were attributed to a moderate- to large-sized pericardial effusion, without evidence of tamponade, as confirmed by echocardiography. The fluid was removed by pericardiocentesis; analysis was negative for malignant cells, inflammatory markers, or microbiologic studies. Reaccumulation of the fluid necessitated placement of a pericardial window, resulting in the resolution of his symptoms. There are limited case reports demonstrating the association of pericardial effusion with COVID-19 infection. The effusion is likely secondary to the inflammatory response leading to capillary leakage, resulting in pericardial fluid traversing the serous pericardium. In addition to other demonstrated cardiovascular effects, COVID-19 appears to be associated with recurrent pericardial effusion. Due to the rise in COVID-19 cases, it is essential to consider pericardial effusion as a rare but potential complication of this virus. The pericardial effusion can be the primary clinical manifestation, recurrent in nature, and potentially result in tamponade physiology.
Highlights
Severe acute respiratory syndrome coronavirus (SARS-CoV-2) emerged from Wuhan, China, in 2019, resulting in coronavirus disease 19 (COVID-19) and a global pandemic that affected millions of people worldwide
We present a case of a patient who presented with recurrent pericardial effusions likely secondary to COVID-19 infection
SARS-CoV-2 binds to the angiotensin-converting enzyme 2 (ACE2) to activate the ACE2 signaling pathway, which induces myocardial injury leading to pericardial effusion
Summary
Severe acute respiratory syndrome coronavirus (SARS-CoV-2) emerged from Wuhan, China, in 2019, resulting in coronavirus disease 19 (COVID-19) and a global pandemic that affected millions of people worldwide. We present a case of a patient who presented with recurrent pericardial effusions likely secondary to COVID-19 infection. The patient was found to be COVID positive on SARS-CoV-2 RNA testing He left against medical advice two days later. TTE showed a large pericardial effusion with diastolic compression of the right atrium, consistent with cardiac tamponade physiology. He underwent pericardiocentesis with the removal of 800 ml serosanguinous fluid that was negative for malignant cytology. The patient was referred to the ED for bilateral lower extremity cellulitis On this most recent ED visit, approximately four months after the initial presentation, the patient agreed to stay in the hospital and undergo a comprehensive diagnostic evaluation. The patient’s clinical presentation improved, and he was discharged home
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