UREMIC PERICARDITIS IN A COVID-19 PATIENT

Background

The clinical syndrome of COVID-19 was first diagnosed in late 2019 in Wuhan, China. This syndrome is a result of Infection with coronavirus SARS-CoV-2 and it has a wide spectrum of clinical presentation. We report a case of COVID-19 pneumonia associated with uremic pericarditis

Case

56 yo female with history of hypertension came to the hospital with dyspnea and chest discomfort for 7 days. Physical examination revealed hypoxia with O2 saturation of 60%, lung rales, and no JVP. Labs showed leucopenia, creatinine 2.1mg/dL and troponin 0.07 ng/ml. ECG showed sinus rhythm with right bundle branch block (Panel A). SARS-COV 2 PCR test was positive for COVID-19. Patient decompensated requiring intubation.

Decision-making

Chest x-ray showed cardiomegaly with pulmonary infiltrates. Echocardiogram revealed large pericardial effusion with no evidence of tamponade (Panel B). Creatinine increased to 4.1 mg/dL and patient became oliguric. The patient was diagnosed with COVID-19 pneumonia along with uremic pericarditis. She was placed on dexamethasone and Remdesivir. The decision for daily dialysis was made along with serial echocardiogram follow up for the effusion. Her pericardial effusion improved and she was extubated. She was discharged to a skilled nursing facility

Conclusion

A consideration of uremic pericarditis along with myocardial inflammation is important in patients with COVID-19 pneumonia. The management is challenging, and this condition is associated with adverse outcomes.