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McBenedict B, Ahmed YA, Reda Elmahdi R, Yusuf WH, Netto JGM, Valentim G, Abrahão A, Lima Pessôa B, Mesquita ET. Pericardial Diseases Mortality Trends in Brazil From 2000 to 2022. Cureus 2024; 16:e57949. [PMID: 38738132 PMCID: PMC11084855 DOI: 10.7759/cureus.57949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/10/2024] [Indexed: 05/14/2024] Open
Abstract
Background Pericardial diseases manifest in various clinical forms, including acute pericarditis, constrictive pericarditis, pericardial effusion, and cardiac tamponade, with acute pericarditis being the most prevalent. These conditions significantly contribute to mortality rates. Therefore, this article aimed to analyze mortality trends in the Brazilian population based on age and sex, shedding light on the impact of pericardial diseases on public health outcomes. Methods This is a retrospective time-series analysis of pericardial disease mortality rates in Brazil (2000-2022). Data was obtained from the Department of Informatics of the Unified Health System (DATASUS), and the 10th edition of the International Classification of Diseases (ICD-10) codes: I30, I31, and I32 were included for analysis. We gathered population and demographic data categorized by age range and sex from the Brazilian Institute of Geography and Statistics (IBGE). Subsequently, we computed the age-standardized mortality rate per 100,000 individuals and assessed the annual percentage changes (APCs) and average annual percentage changes (AAPCs) using joinpoint regression, along with their corresponding 95% confidence intervals (CIs). Results In terms of mortality trends based on sex, overall mortality rates remained stable for males and combined sexes over the study period. However, there was a notable increase in mortality rates among females (AAPC=1.18), particularly between 2020 and 2022, with a significant APC of 27.55. Analyzing pericardial diseases across different age groups (20 to 80 years and above), it wasobserved that mortality rates significantly increased in the 70-79 and 80 years and above age groups throughout the study period (AAPC=1.0339 and AAPC=3.4587, respectively). These two age groups experienced the highest significant rise in mortality between 2020 and 2022. Other age groups did not exhibit a significant change in AAPC. Conclusions This comprehensive analysis spanning two decades (2000-2022), examined the mortality trends of pericardial diseases in Brazil and revealed relative stability overall. Males exhibited an overall higher mortality number due to pericardial diseases; however, females showed the most significant increase in mortality trend throughout the whole period. In the first segment (2000-2015), mortality rose across all cohorts, which was attributed to substandard healthcare facilities and infectious diseases like tuberculosis. The second segment (2016-2020) saw a decline in mortality, likely due to improved healthcare, particularly the increased availability of echocardiograms. However, the third segment (2020-2022) witnessed a sharp rise in mortality, coinciding with the COVID-19 pandemic, with post-COVID-19 symptoms, particularly pericarditis. Pericarditis-related death rates declined compared to pericardial effusion, and mortality rates correlated directly with age, with older cohorts experiencing higher mortality due to increased comorbidities, and decline in health and immunocompetency.
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Affiliation(s)
| | | | | | | | | | | | - Ana Abrahão
- Public Health, Fluminense Federal University, Niterói, BRA
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2
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Noghabaei G, Arab M, Payami S, Ghavami B. Acute Pericarditis as the Primary Presentation of COVID-19 Infection followed by Guillain-Barre Syndrome in a Healthy Young Man: A Case Report. Open Respir Med J 2022. [DOI: 10.2174/18743064-v16-e221020-2022-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background:
Symptomatic COVID-19 infection most often presents as acute respiratory distress syndrome. Acute pericarditis and Guillain–Barré syndrome are rare extrapulmonary manifestations of this infection.
Case Presentation:
A 27-year-old man presented with chest pain, with negative troponin and typical electrocardiographic findings, resulting in a diagnosis of acute pericarditis. He had no respiratory symptoms, nor the chest computerized tomography (CT) scan findings of COVID-19, and his Polymerase chain reaction (PCR) was negative. One week later, he developed clinical symptoms of Guillain-Barre syndrome, along with respiratory manifestations of COVID-19. His repeat chest CT scan and PCR test confirmed COVID-19 infection. After 17 days of hospital stay, he improved clinically and was discharged.
Conclusion:
This is the first case of acute pericarditis as the primary presentation of COVID-19 in the absence of respiratory symptoms and a clear chest CT scan, followed by the development of Guillain–Barré syndrome and respiratory tract manifestations of COVID-19. Clinicians should be aware of the extrapulmonary presentation of COVID-19 infection.
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Theetha Kariyanna P, Sabih A, Sutarjono B, Shah K, Vargas Peláez A, Lewis J, Yu R, Grewal ES, Jayarangaiah A, Das S, Jayarangaiah A. A Systematic Review of COVID-19 and Pericarditis. Cureus 2022; 14:e27948. [PMID: 36120210 PMCID: PMC9464705 DOI: 10.7759/cureus.27948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 11/16/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first identified in Wuhan, China in December 2019. Since then, the disease has spread globally, leading to the ongoing pandemic. It can cause severe respiratory illness; however, many cases of pericarditis have also been reported. This systematic review aims to recognize the clinical features of pericarditis and myopericarditis in COVID-19 patients. Google Scholar, Medline/PubMed, CINAHL, Cochrane Central, and Web of Science databases were searched for studies reporting “Coronavirus” or “COVID” and “Peri-myocarditis,” “heart,” or “retrospective.” Case reports and retrospective studies published from May 2020 to February 2021 were reviewed. In total, 33 studies on pericarditis, myopericarditis, and pericardial infusion were included in this review. COVID-19 pericarditis affected adult patients at any age. The incidence is more common in males, with a male-to-female ratio of 2:1. Chest pain (60%), fever (51%), and shortness of breath (51%) were the most reported symptoms, followed by cough (39%), fatigue (15%), myalgia (12%), and diarrhea (12%). Laboratory tests revealed leukocytosis with neutrophil predominance, elevated D-dimer, erythrocyte rate, and C-reactive protein. Cardiac markers including troponin-1, troponin-T, and brain natriuretic peptide were elevated in most cases. Radiographic imaging of the chest were mostly normal, and only 31% of chest X-rays showed cardiomegaly and or bilateral infiltration. Electrocardiography (ECG) demonstrated normal sinus rhythm with around 59% ST elevation and rarely PR depression or T wave inversion, while the predominant echocardiographic feature was pericardial effusion. Management with colchicine was favored in most cases, followed by non-steroidal anti-inflammatory drugs (NSAIDs), and interventional therapy was only needed when patient developed cardiac tamponade. The majority of the reviewed studies reported either recovery or no continued clinical deterioration. The prevalence of COVID-19-related cardiac diseases is high, and pericarditis is a known extrapulmonary manifestation. However, pericardial effusion and cardiac tamponade are less prevalent and may require urgent intervention to prevent mortality. Pericarditis should be considered in patients with chest pain, ST elevation on ECG, a normal coronary angiogram, and COVID-19. We emphasize the importance of clinical examination, ECG, and echocardiogram for decision-making, and NSAIDs, colchicine, and corticosteroids are considered to be safe in the treatment of pericarditis/myopericarditis associated with COVID-19.
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Rodrigo Domínguez D, Rueda Cid A, Campos Fernández C, Molina Almeda C, Lerma Garrido JJ, Pastor Cubillo MD. Recurrent pericarditis after Covid-19. REUMATOLOGÍA CLÍNICA (ENGLISH EDITION) 2022; 18:435-436. [PMID: 34961692 PMCID: PMC9359891 DOI: 10.1016/j.reumae.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/08/2021] [Indexed: 12/04/2022]
Abstract
Patient with rheumatoid arthritis who has Covid-19 with recurrent pericaditis debut, differential diagnosis.
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Affiliation(s)
- David Rodrigo Domínguez
- Servicio de Medicina Interna, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Amalia Rueda Cid
- Servicio de Reumatología y Metabolismo Óseo, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
| | - Cristina Campos Fernández
- Servicio de Reumatología y Metabolismo Óseo, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Clara Molina Almeda
- Servicio de Reumatología y Metabolismo Óseo, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Juan José Lerma Garrido
- Servicio de Reumatología y Metabolismo Óseo, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - M Dolores Pastor Cubillo
- Servicio de Reumatología y Metabolismo Óseo, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
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Piccioni A, Saviano A, Cicchinelli S, Franza L, Rosa F, Zanza C, Santoro MC, Candelli M, Covino M, Nannini G, Amedei A, Franceschi F. Microbiota and Myopericarditis: The New Frontier in the Car-Diological Field to Prevent or Treat Inflammatory Cardiomyo-Pathies in COVID-19 Outbreak. Biomedicines 2021; 9:1234. [PMID: 34572420 PMCID: PMC8468627 DOI: 10.3390/biomedicines9091234] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/09/2021] [Accepted: 09/13/2021] [Indexed: 02/05/2023] Open
Abstract
Myopericarditis is an inflammatory heart condition involving the pericardium and myocardium. It can lead to heart failure, dilated cardiomyopathy, arrhythmia and sudden death. Its pathogenesis is mainly mediated by viral infections but also can be induced by bacterial infections, toxic substances and immune mediated disorders. All these conditions can produce severe inflammation and myocardial injury, often associated with a poor prognosis. The specific roles of these different pathogens (in particular viruses), the interaction with the host, the interplay with gut microbiota, and the immune system responses to them are still not completely clear and under investigation. Interestingly, some research has demonstrated the contribution of the gut microbiota, and its related metabolites (some of which can mimic the cardiac myosin), in cardiac inflammation and in the progression of this disease. They can stimulate a continuous and inadequate immune response, with a subsequent myocardial inflammatory damage. The aim of our review is to investigate the role of gut microbiota in myopericarditis, especially for the cardiovascular implications of COVID-19 viral infection, based on the idea that the modulation of gut microbiota can be a new frontier in the cardiological field to prevent or treat inflammatory cardiomyopathies.
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Affiliation(s)
- Andrea Piccioni
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (S.C.); (L.F.); (F.R.); (M.C.S.); (M.C.); (M.C.); (F.F.)
| | - Angela Saviano
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (S.C.); (L.F.); (F.R.); (M.C.S.); (M.C.); (M.C.); (F.F.)
| | - Sara Cicchinelli
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (S.C.); (L.F.); (F.R.); (M.C.S.); (M.C.); (M.C.); (F.F.)
| | - Laura Franza
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (S.C.); (L.F.); (F.R.); (M.C.S.); (M.C.); (M.C.); (F.F.)
| | - Federico Rosa
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (S.C.); (L.F.); (F.R.); (M.C.S.); (M.C.); (M.C.); (F.F.)
| | - Christian Zanza
- Department of Anesthesia, Critical Care and Emergency Medicine, Pietro and Michele Ferrero Hospital, Foundation Nuovo-Ospedale Alba-Bra, 12060 Verduno, Italy;
| | - Michele Cosimo Santoro
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (S.C.); (L.F.); (F.R.); (M.C.S.); (M.C.); (M.C.); (F.F.)
| | - Marcello Candelli
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (S.C.); (L.F.); (F.R.); (M.C.S.); (M.C.); (M.C.); (F.F.)
| | - Marcello Covino
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (S.C.); (L.F.); (F.R.); (M.C.S.); (M.C.); (M.C.); (F.F.)
| | - Giulia Nannini
- Department of Experimental and Clinical Medicine, University of Firenze, 50134 Firenze, Italy; (G.N.); (A.A.)
| | - Amedeo Amedei
- Department of Experimental and Clinical Medicine, University of Firenze, 50134 Firenze, Italy; (G.N.); (A.A.)
| | - Francesco Franceschi
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (S.C.); (L.F.); (F.R.); (M.C.S.); (M.C.); (M.C.); (F.F.)
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6
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Diaz-Arocutipa C, Saucedo-Chinchay J, Imazio M. Pericarditis in patients with COVID-19: a systematic review. J Cardiovasc Med (Hagerstown) 2021; 22:693-700. [PMID: 33927144 DOI: 10.2459/jcm.0000000000001202] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
AIMS We performed a systematic review to summarize the clinical features, diagnostic methods, treatment, and outcomes of coronavirus disease 2019 (COVID-19) patients with pericarditis. METHODS We searched electronic databases from inception to 17 December 2020. Studies that reported clinical data on patients with COVID-19 and pericarditis were included. Descriptive statistics were used for categorical and continuous variables [mean ± standard deviation or median (interquartile range)]. As an exploratory analysis, differences between patients with acute pericarditis and myopericarditis were compared. RESULTS A total of 33 studies (32 case reports and 1 case series) involving 34 patients were included. The mean age was 51.6 ± 19.5 years and 62% of patients were men. Sixty-two percentage of patients were diagnosed with myopericarditis. The most frequent electrocardiographic pattern (56%) was diffuse ST-elevation and PR depression. Pericardial effusion and cardiac tamponade were reported in 76 and 35% of cases, respectively. The median values of C-reactive protein [77 mg/dl (12-177)] and white blood cells [12 335 cells/μl (5625-16 500)] were above the normal range. Thirty-eight percent and 53% of patients were treated with nonsteroidal anti-inflammatory drugs (NSAIDs) and colchicine, respectively. These drugs were more frequently used in patients with acute pericarditis compared with myopericarditis. The in-hospital mortality was 6% without a significant difference between both groups. CONCLUSION Our review shows that COVID-19 patients with pericarditis had similar clinical features to other viral cardiotropic infections. However, NSAIDs and colchicine were used in half or less of the cases. Overall, the short-term prognosis was good across groups.
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Affiliation(s)
- Carlos Diaz-Arocutipa
- Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
- Asociación para el Desarrollo de la Investigación Estudiantil en Ciencias de la Salud (ADIECS), Lima, Peru
- Programa de Atención Domiciliaria (PADOMI), EsSalud, Lima, Peru
| | | | - Massimo Imazio
- Cardiology, Cardiothoracic Department, University Hospital "Santa Maria della Misericordia", ASUFC, Udine, Italy
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Rodrigo Domínguez D, Rueda Cid A, Campos Fernández C, Molina Almeda C, Lerma Garrido JJ, Pastor Cubillo MD. Recurrent Pericarditis After Covid-19. REUMATOLOGIA CLINICA 2021; 18:S1699-258X(21)00168-6. [PMID: 34417134 PMCID: PMC8372486 DOI: 10.1016/j.reuma.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/22/2021] [Accepted: 07/08/2021] [Indexed: 11/27/2022]
Abstract
Patient with rheumatoid arthritis who has Covid-19 with recurrent pericaditis debut, differential diagnosis.
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Affiliation(s)
- David Rodrigo Domínguez
- Servicio de Medicina Interna, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - Amalia Rueda Cid
- Servicio de Reumatología y Metabolismo Óseo, Consorcio Hospital General Universitario de Valencia, Valencia, España.
| | - Cristina Campos Fernández
- Servicio de Reumatología y Metabolismo Óseo, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - Clara Molina Almeda
- Servicio de Reumatología y Metabolismo Óseo, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - Juan Jóse Lerma Garrido
- Servicio de Reumatología y Metabolismo Óseo, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - M Dolores Pastor Cubillo
- Servicio de Reumatología y Metabolismo Óseo, Consorcio Hospital General Universitario de Valencia, Valencia, España
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Furqan MM, Verma BR, Cremer PC, Imazio M, Klein AL. Pericardial Diseases in COVID19: a Contemporary Review. Curr Cardiol Rep 2021; 23:90. [PMID: 34081219 PMCID: PMC8173318 DOI: 10.1007/s11886-021-01519-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW Coronavirus disease 2019 (COVID19) involves the heart, including pericardium. This article reviews the possible pathophysiological mechanisms in pericardial involvement in COVID19 and pericardial manifestations of COVID19. It also summarizes the patients with pericarditis secondary to COVID19 and outlines the contemporary treatment strategies in this patient population. RECENT FINDINGS A high degree of suspicion is required to identify the pericardial involvement in COVID19 patients. It is proposed that an underlying hyperinflammatory reaction in COVID19 leads to pericardial inflammation. Acute pericarditis with or without myocardial involvement is diagnosed on clinical presentation, serum inflammatory markers, electrocardiogram, and echocardiogram. Multimodality imaging may also have an additional diagnostic value. Patients are usually managed medically, but some patients develop a life-threatening pericardial tamponade necessitating pericardial drainage. Pericardial involvement is an important clinical manifestation of COVID19 requiring a proper workup. Timely diagnosis and a specific management plan based on the presentation and concomitant organ involvement usually lead to a complete recovery.
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Affiliation(s)
- Muhammad M Furqan
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Beni R Verma
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Paul C Cremer
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Massimo Imazio
- Cardiothoracic Department, University Hospital "Santa Maria della Misericordia", Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), Piazzale Santa Maria della Misericordia 15,, 33100 Udine, Italy
| | - Allan L Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
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9
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Beckerman JK, Alarfaj M, Tracy CM, Faiwiszewski AD, Choi AD. Coronavirus disease 2019 (COVID-19)-associated constrictive pericarditis. BMJ Case Rep 2021; 14:14/5/e242018. [PMID: 33975843 PMCID: PMC8117986 DOI: 10.1136/bcr-2021-242018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
This report documents a rare case of COVID-19-associated constrictive pericarditis (CP) in the setting of a recent COVID-19 infection. A 55-year-old man with a history of hypertension and gout presented with acute hypoxic respiratory failure and was diagnosed with COVID-19 pneumonia with progression to acute respiratory distress syndrome. His hospital course was complicated by a large pericardial effusion; an emergent bedside transthoracic echocardiography was concerning for cardiac tamponade, so pericardiocentesis was performed. A workup with cardiac magnetic resonance imaging showed changes consistent with a diagnosis of CP. Viral and idiopathic aetiologies are the most common cause of CP in the developed world, with COVID-19 now a proposed predisposing viral illness. The virus induces systemic inflammation and pericardial changes that can lead to CP physiology. Imaging modalities including echocardiogram and cardiac magnetic resonance play an integral role in confirming the diagnosis.
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Affiliation(s)
- Jennifer Kate Beckerman
- Department of Internal Medicine, George Washington University School of Medicine, Washington, DC, USA
| | - Mohammad Alarfaj
- Department of Internal Medicine, George Washington University School of Medicine, Washington, DC, USA
| | - Cynthia M Tracy
- Division of Cardiology, George Washington University School of Medicine, Washington, DC, USA
| | - Ariel D Faiwiszewski
- Division of Cardiology, George Washington University School of Medicine, Washington, DC, USA
| | - Andrew D Choi
- Division of Cardiology and Department of Radiology, George Washington University School of Medicine, Washington, DC, USA
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10
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Sollie ZW, Vallepu SR, Tharumia Jagadeesan C, White LC, Nagalapuram V. Challenges in Managing Pericardial Disease Related to Post Viral Syndrome After COVID-19 Infection. Cureus 2021; 13:e13461. [PMID: 33777550 PMCID: PMC7984891 DOI: 10.7759/cureus.13461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2021] [Indexed: 12/16/2022] Open
Abstract
Although primarily a respiratory illness, coronavirus disease 2019 (COVID-19) has been associated with cardiac involvement with reported cases of myocardial ischemia, arrhythmia, myocarditis, pericarditis, and pericardial effusion leading to cardiac tamponade. Most cases of pericardial disease in this setting have been during the acute infection. Here, we present a patient who developed pericarditis leading to cardiac tamponade after the resolution of the acute COVID-19 infection. Her course of illness was further complicated by poor response to initial medical therapy with non-steroidal anti-inflammatory drugs (NSAIDs) and colchicine which could possibly be related to early exposure to steroids. It is often difficult to establish an underlying etiology for acute pericarditis. Similarly, in our case, although there is no definitive test to prove the causal relationship, this effusion is highly suspicious of being secondary to post viral sequelae after COVID-19 infection when considering the clinical course. It is important to consider pericardial disease as a late complication of COVID-19 even after apparent resolution of the acute infection and be mindful of the therapeutic challenges that we might face while managing such patients.
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Affiliation(s)
- Zachary W Sollie
- Internal Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, USA
| | - Shirisha R Vallepu
- Internal Medicine, University of Alabama at Birmingham, Montgomery Internal Medicine, Montgomery, USA
| | | | - Lori C White
- Internal Medicine, University of Alabama at Birmingham, Montgomery Internal Medicine, Montgomery, USA
| | - Vishnu Nagalapuram
- Internal Medicine, University of Alabama at Birmingham, Montgomery Internal Medicine, Montgomery, USA
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Streicher C, Engalenc X, Gaudin M, Vignaud G, Daulange A, Abraham B. Could Tocilizumab be an Attractive Therapeutic Option for Elderly Patients with Severe COVID-19? A Case Report. Clin Drug Investig 2020; 40:1085-1088. [PMID: 32951190 PMCID: PMC7502217 DOI: 10.1007/s40261-020-00969-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Caroline Streicher
- Unité de préparation et de contrôle pharmaceutique (UPCP), Centre Hospitalier de Brive La Gaillarde, 1 boulevard du Dr Verlhac, 19312, Brive la Gaillarde Cedex, France.
| | - Xavier Engalenc
- Médecine interne et Maladies infectieuses, Centre Hospitalier de Brive La Gaillarde, 1 boulevard du Dr Verlhac, 19312, Brive la Gaillarde Cedex, France
| | - Marion Gaudin
- Médecine interne et Maladies infectieuses, Centre Hospitalier de Brive La Gaillarde, 1 boulevard du Dr Verlhac, 19312, Brive la Gaillarde Cedex, France
| | - Guillaume Vignaud
- Médecine interne et Maladies infectieuses, Centre Hospitalier de Brive La Gaillarde, 1 boulevard du Dr Verlhac, 19312, Brive la Gaillarde Cedex, France
| | - Annick Daulange
- Unité de préparation et de contrôle pharmaceutique (UPCP), Centre Hospitalier de Brive La Gaillarde, 1 boulevard du Dr Verlhac, 19312, Brive la Gaillarde Cedex, France
| | - Bruno Abraham
- Médecine interne et Maladies infectieuses, Centre Hospitalier de Brive La Gaillarde, 1 boulevard du Dr Verlhac, 19312, Brive la Gaillarde Cedex, France
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