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Published on: December 19, 2020
Symptomatic pericardial effusion in the setting of asymptomatic COVID-19 infection: A case report
Behzad Amoozgar1,2, Varun Kaushal1, Umair Mubashar1
1Department of Internal Medicine, Jersey Shore University Medical Center, Perth Amboy Division.
Insights
Severe acute respiratory syndrome coronavirus disease 2019 (COVID-19) can cause pericardial effusion, even in asymptomatic cases. Early diagnosis and intervention are crucial for preventing severe outcomes like cardiac tamponade.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- COVID-19 infection can lead to multi-organ involvement, including inflammation of the cardiopulmonary serosal layers.
- Pericarditis and pericardial effusion are potential complications of COVID-19, sometimes occurring without typical respiratory symptoms.
Observation:
- A rare case of pericardial effusion in an asymptomatic patient with COVID-19 presenting with chest pain is described.
- Initial COVID-19 diagnostic tests (RT-PCR) were negative, but subsequent testing and serology confirmed the infection, suggesting reinfection or a subacute presentation.
Findings:
- Echocardiography revealed a large circumferential pericardial effusion with mild pericardial thickening.
- The patient successfully underwent a pericardial window procedure and medical management, leading to complete resolution of the effusion upon follow-up.
Implications:
- Clinicians should maintain a high index of suspicion for pericardial effusion in patients with unexplained chest pain, even with negative initial COVID-19 tests.
- Prompt diagnosis and management of COVID-19-associated pericardial effusion are essential to prevent serious complications such as cardiac tamponade.
Rationale:
Infection with the severe acute respiratory coronavirus disease 2019 (COVID-19) has been shown to cause multi-organ involvement including cardiopulmonary serosal layers infection and inflammation. As a result, pericarditis and pericardial effusion may occur with or without COVID-19 related respiratory signs. Due to limitations in sensitivity and specificity of current COVID-19 diagnostic studies, cases that trigger high clinical intuition, even with negative serologic and polymerase chain reaction testing results, may necessitate further diagnostic workup to discover the underlying etiology.
Patient Concerns:
Here we present a rare case of pericardial effusion in the setting of asymptomatic COVID-19 infection manifesting with the chief complaint of chest pain.
Diagnosis:
While undergoing diagnostic workup, the patients first 2 sets of COVID 19 reverse transcription-polymerase chain reaction (RT-PCR) were negative while a latter RT-PCR test, as well as serology, were positive, leading to the diagnosis of COVID-19 reinfection or subacute presentation of viral infection with pericardial effusion. Echocardiogram depicted large circumferential pericardial effusion with mildly thickened pericardium.
Interventions:
The patient underwent pericardial window placement followed by ibuprofen administration and discharged from the hospital.
Outcomes:
During the follow-up visit patient had no symptoms and echocardiogram demonstrated complete resolution of the effusion.
Lessons:
Due to the possible establishment of pericardial effusions and consecutively tamponade even without any COVID-19 related clinical presentation, it is crucial for clinicians to trust their intuition, conduct the appropriate diagnostic tests, find the underlying diagnosis and prevent the devastating consequences.
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