Subacute effusive-constrictive pericarditis in a patient wit
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Considered in the beginning a respiratory illness, with the increase in cases it became evident that SARS-CoV-2 infection affects multiple organs, including the heart. The cardiovascular changes range from asymptomatic increase in myocardial injury markers, contractility disorders, arrhythmias, pericardial disease, vascular insufficiency and sudden cardiac arrest. Authors report the case of a rapidly installed constrictive pericarditis in the setting of COVID-19.

A 27-year-old woman presented to the emergency department for fever, dry cough, chest pain and breathlessness. Symptoms started 3 weeks prior with fever and dry cough while working in Germany, where she was tested negative for COVID-19 and received symptomatic treatment. She had no comorbidities but reported a history of alcohol abuse in remission for 5 years. She denied a personal history of tuberculosis (TB) or any known TB contacts. At presentation, she was tachypnoeic (respiratory rate 30/min), oxygen saturation was 90% and auscultation of the lungs revealed diminished breath sound on the left side. Her pulse was 100/min with a blood pressure of 120/70 mm Hg. Auscultation of the heart was normal.

The ECG revealed sinus tachycardia, without other changes. Initial laboratory studies revealed mild leucocytosis with lymphopenia, mild thrombocytosis, and elevated inflammatory markers including: D-dimer 5 µg/mL, fibrinogen 653 mg/dL (200–390 mg/dL), ferritin 950 ng/mL (30–400 ng/mL), lactate dehydrogenase 660 U/L (125–220 U/L), C reactive protein 160 mg/L (0–5 mg/L). The liver and kidney function were within normal values. Chest X-ray showed extensive left pulmonary consolidation with moderate pleural effusion and mild tracheal deviation to the right side. A CT scan of the chest showed pneumonia in the left lobe with left pleural effusion, and moderate pericardial effusion.

Given the high clinical probability of COVID-19, she was admitted to the isolation unit and retested with COVID-19 real-time reverse transcriptase-PCR (RT-PCR) assay, which came positive this time. She was treated with oxygen, corticosteroids, colchicine, low molecular weight heparin and broad-spectrum antibiotic, for 5 days, without improvement.

Source: https://casereports.bmj.com/content/14/6/e242443?rss=1
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