Pericardial Fluid in a COVID-19 Patient: Is It Exudate or Tr
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A 41-year-old female patient was referred to the hospital with COVID-19 and pericardial effusion. She had been admitted to the referring hospital 10 days previously with a sore throat, cough and shortness of breath. Her medical history was negative for chronic disease, but she had been in contact with an individual with COVID-19.

The ECG showed sinus tachycardia, with no ischaemic changes. An echocardiogram demonstrated a large pericardial effusion, with early signs of tamponade in the form of right atrial systolic collapse. A chest x-ray revealed cardiomegaly, and smooth cardiac boarders suggestive of pericardial effusion. A CT scan of the chest showed ground-glass opacities in the right and left lower lung lobes and a large pericardial effusion. A nasal swab was positive for COVID-19.

The patient was reviewed and managed according to the COVID-19 protocol. Deep vein thrombosis prophylaxis and stress ulcer prophylaxis were initiated. Investigation of the pericardial effusion included an autoimmune screen and thyroid profile. In view of the patient’s symptoms and the echo findings, pericardial aspiration was performed aseptically with appropriate PPE, and 550 ml of pericardial fluid was drained.

It can be concluded that the pericardial fluid was most likely exudative, with remarkably high lactate dehydrogenase (LDH) and albumin levels. The patient was started on azithromycin 500 mg once daily for 3 days and hydroxychloroquine 200 mg twice daily. The patient had improved significantly by day 2, and was discharged well on day 6 to continue isolation at home.

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