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   Table of Contents      
CASE REPORT
Year : 2021  |  Volume : 7  |  Issue : 2  |  Page : 162-164

A Rare Case of COVID-19 Infection Presenting as Massive Pericardial Effusion in Young Adult


Department of Pulmonology, Max Super Speciality Hospital, Ghaziabad, Uttar Pradesh, India

Date of Submission14-Jul-2021
Date of Decision21-Jul-2021
Date of Acceptance30-Jul-2021
Date of Web Publication27-Aug-2021

Correspondence Address:
Nitesh Tayal
Associate consultant, pulmonology, Max super speciality hospital, Ghaziabad 201012, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mamcjms.mamcjms_78_21

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  Abstract 


Novel coronavirus disease 2019 (COVID-19) has emerged as a rapidly spreading viral illness throughout the world. Majority of patients develop pulmonary manifestations. Involvement of extrapulmonary site is rare. We here present a rare case of massive pericardial effusion as a presenting feature of COVID-19 infection.

Keywords: COVID-19, effusion, pericardial


How to cite this article:
Joshi S, Tayal N, Bhatia A. A Rare Case of COVID-19 Infection Presenting as Massive Pericardial Effusion in Young Adult. MAMC J Med Sci 2021;7:162-4

How to cite this URL:
Joshi S, Tayal N, Bhatia A. A Rare Case of COVID-19 Infection Presenting as Massive Pericardial Effusion in Young Adult. MAMC J Med Sci [serial online] 2021 [cited 2021 Dec 6];7:162-4. Available from: https://www.mamcjms.in/text.asp?2021/7/2/162/324745




  Introduction Top


Novel coronavirus (severe acute respiratory syndrome coronavirus 2 or SARS-CoV-2) has emerged as a rapidly spreading viral illness throughout the world.[1] Respiratory system appears to be most commonly affected with this deadly virus.[2] As the number of coronavirus disease 2019 (COVID-19) cases are increasing worldwide, few cases are being identified as having extrapulmonary symptoms.[3] Very few case reports can be found in literature which have shown pericardial involvement due to coronavirus. We are presenting a rare case of massive pericardial effusion as a presenting feature of COVID-19 infection.


  Case Report Top


A 23-year-old female presented in emergency with the complaints of fever, breathlessness, central chest heaviness, and generalized weakness. On examination, she was found to have oxygen saturation 87%, pulse rate 84/min, blood pressure 110/70 mmHg. X-ray chest [Figure 1] carried out which was suggestive of bilateral lung infiltrates with apparent cardiomegaly. Her nasal swab sent for COVID-19 antigen comes out to be positive. Blood investigations showed hemoglobin 8.4 g/dl, total leukocyte count 12,680 cells/mm3, platelet count 3.09 lakh/mm3, C-reactive protein 7.7 mg/dl, interleukin 6 73.77 pg/ml, cardiac enzymes, liver function test, kidney function test were within normal limit. 2D Echo [Figure 2] showed moderate to large pericardial effusion with an ejection fraction of 55%. Subsequently, patient underwent high-resolution computed tomography (HRCT) thorax [Figure 3]a b which showed moderate pericardial effusion along with ground glass haziness with multiple patchy areas of consolidation in both lungs predominantly in the central aspect with relative peripheral sparing. The patient was managed on injection remdesivir, steroids along with other symptomatic and supportive care. Pericardiocentesis was not carried out. Repeat 2D Echo performed after 10 days showed almost complete resolution of pericardial effusion. Follow-up chest X-ray [Figure 4] also showed significant resolution. Follow-up HRCT thorax [Figure 5]a,b also showed almost complete resolution of pericardial effusion along with lung infiltrates. Follow-up COVID-19 polymerase chain reaction sent after 10 days comes out to be negative. Patient also improved clinically and was subsequently discharged on room air.
Figure 1 Chest X-ray suggestive of bilateral lung infiltrates with apparent cardiomegaly.

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Figure 2 2D Echo showing moderate to large pericardial effusion with an ejection fraction.

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Figure 3 (A and B) High-resolution computed tomography of thorax showing moderate pericardial effusion along with ground glass haziness with multiple patchy areas of consolidation in both lungs predominantly in the central aspect with relative peripheral sparing.

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Figure 4 Follow-up chest X-ray.

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Figure 5 (A and B) Follow-up high-resolution computed tomography thorax.

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  Discussion Top


The SARS-CoV-2 has infected over 9.5 million people and has caused more than 480,000 deaths globally, as of June 24, 2020.[4]

François Sauer reported three cases of pericardial effusion. There is a higher incidence of COVID-19-related pericardial involvement that can manifest from mild pericardial effusion to cardiac tamponade.[1] Fox et al. reported a rare case of acute pericarditis presenting with pericardial effusion and cardiac tamponade in a 43-year-old man diagnosed with COVID-19.[3]

Behzad Amoozgar et al. presented a case of an otherwise healthy 56-year-old man with pericardial involvement in the setting of COVID-19 infection.[5]

As this disease has progressed into a global pandemic and millions of people have become infected, its extrapulmonary manifestations have become better understood.[6] Cardiac involvement usually consists of myocarditis but the spectrum is widening as more cases are reported. Incidental pericardial effusion has been reported in 4.55% of all CT scans of the chest.[7]

Although the pathophysiology of pericardial effusion in COVID-19 is unknown, it is hypothesized that it occurs secondary to the systemic inflammatory response and the subsequent cytotoxic and immune-mediated effects related to SARS-CoV-2.[8] Although ultrastructural mechanisms are not clear, binding to a viral receptor of the myocyte can favor the internalization and subsequent replication of the capsid proteins and the viral genome.[9] When the spectrum of clinical manifestation is highly related to the inflammation process of the respiratory tract, case report by Inciardi et al. provides evidence of cardiac involvement as a possible late phenomenon of the viral respiratory infection.[10]

As of now, no guidelines are available regarding the management of COVID-19-related pericardial disease.[1] In various case reports, patients were treated with colchicine, hydroxychloroquine, steroids, and antivirals as per their institutional protocols.[6],[11] Center for disease control states that NSAIDs and glucocorticoids can be used when clinically indicated.[12] Various other studies have proposed a potential beneficial effect of corticosteroids as a treatment during cytokine storm syndrome.[13] Colchicine has come up as an interesting treatment option in COVID-19 infection, as suggested in ongoing prospective studies (GRECCO-19 study).[14] In our case, we had prescribed steroids along with remdesivir and subsequently observed a dramatic response within a short span of time.


  Conclusion Top


As the number of COVID-19 cases is increasing worldwide, patients may develop extrapulmonary manifestations. We conclude from this case that COVID-19 infection can have atypical manifestations and a high index of suspicion is needed for evaluation of such cases.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
François Sauer, Charlotte Dagrenat, Philippe Couppie, Gaelle Jochum, Pierre Leddet. Pericardial effusion in patients with COVID-19: case series. Eur Heart J Case Rep 2020;4:1-7.  Back to cited text no. 1
    
2.
Huang C, Wang Y, Li X et al. Clinical features of patients infected with2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.  Back to cited text no. 2
    
3.
Fox K, Prokup JA, Butson K et al. Acute effusive pericarditis: a late complication of COVID-19. Cureus 2020;12:e9074.  Back to cited text no. 3
    
4.
Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis 2020;20:533-4.  Back to cited text no. 4
    
5.
Behzad Amoozgar, Varun Kaushal, Umair Mubashar, Shuvendu Sen, Shakeel Yousaf, Matthew Yotsuya. Symptomatic pericardial effusion in the setting of asymptomatic COVID-19 infection. A case report. Medicine 2020;99:37.  Back to cited text no. 5
    
6.
Inciardi RM, Lupi L, Zaccone G et al. Cardiac involvement in a patient with coronavirus disease 2019 (COVID-19). JAMA Cardiol 2020;5:819-24.  Back to cited text no. 6
    
7.
Bao C, Liu X, Zhang H, Li Y, Liu J. Coronavirus disease2019 (COVID-19) CT findings: a systematic review and meta-analysis. J Am Coll Radiol 2020;17:701-9  Back to cited text no. 7
    
8.
Dabbagh MF, Aurora L, D’Souza P, Weinmann AJ, Bhargava P, Basir MB. Cardiac tamponade secondary to COVID-19. JACC Case Rep 2020;2:1326-30.  Back to cited text no. 8
    
9.
Liu PP, Mason JW. Advances in the understanding of myocarditis. Circulation 2001;104:1076-82.  Back to cited text no. 9
    
10.
Inciardi RM, Lupi L, Zaccone G et al. Cardiac involvement in a patient with coronavirus disease 2019 (COVID-19). JAMA Cardiol 2020;5:819-24.  Back to cited text no. 10
    
11.
Asif T, Kassab K, Iskander F, Alyousef T. Acute pericarditis and cardiac tamponade in a patient with COVID 19: a therapeutic challenge. Eur J Case Rep Intern Med 2020;7:001701.  Back to cited text no. 11
    
12.
Centers for Disease Control and Prevention. CDC. Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19).  Back to cited text no. 12
    
13.
Atri D, Siddiqi HK, Lang J, Nauffal V, Morrow DA, Bohula EA. COVID-19 for the cardiologist: a current review of the virology, clinical epidemiology, cardiac and other clinical manifestations and potential therapeutic strategies. JACC Basic Transl Sci 2020;5:518-36.  Back to cited text no. 13
    
14.
Deftereos SG, Siasos G, Giannopoulos G. The Greek study in the effects of colchicine in COVID-19 complications prevention (GRECCO-19 study): rationale and study design. Hellenic J Cardiol 2020;61:42-5.  Back to cited text no. 14
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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