Symptomatic pericardial effusion in the setting of asymptomatic COVID-19 infection: A case report.

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.