Delayed pericarditis in a patient with COVID-19 pneumonia: a case report
Authors: Christian C Toquica Gahona, Kavin Raj, Monarch Shah, Kesavan Sankaramangalam, Riya J Shah, Keval V Patel
Background: Severe acute respiratory syndrome has been implicated in a wide spectrum of cardiovascular complications, from mild elevation in troponins to more severe cases such as pericarditis, cardiac tamponade, and myocarditis. We present a case of delayed onset of pericarditis in a patient with COVID-19 pneumonia. Case Presentation: A 68-year-old woman presented to the emergency department with fever for 5 days, weakness, and fatigue. Diagnosis of COVID-19 pneumonia with superimposed bacterial infection was made. By day 22 of hospitalization, new T wave elevations were seen in cardiac monitoring and confirmation was made with EKG and diagnosis of pericarditis was made. Initial troponin was <0.03 ng/ml and repeated one increased to 1.8 ng/ml (upper limit of normal: 0.12 ng/ml). Treatment was initiated with a high dose of aspirin 650 mg oral daily. Repeat set of troponins downtrended to normal values <0.03 ng/ml. The patient died on day 25 of illness due to worsening shock. Recent reports suggest that the development of fulminant myocarditis and severe cardiac damage experiences a 10-15-day delay following the onset of symptoms from COVID-19 pneumonia, presumably after activated T-cells and macrophages infiltrate myocardial cells. Treatment options include the use of colchicine, corticosteroids, and NSAIDs. Other interventions such as the use of azathioprine, non-human immunoglobulins, and anakinra have been described as well, but there is lack of solid evidence for their benefits. Conclusion: Preliminary information about the mechanisms of developing COVID-19 pericarditis may indicate that colchicine and steroids would be a reasonable treatment option. The efficacy and safety of these medications are to be elucidated.
Keywords: ARDS, Case report, Critical care, COVID-19, Pericarditis SARS-CoV2.
Authors
Christian C Toquica Gahona
Internal Medicine Department, Saint Peters University Hospital, Rutgers-Robert Wood Johnson University Hospital, New Brunswick, NJ
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Kesavan Sankaramangalam
Internal Medicine Department, Saint Peters University Hospital, Rutgers-Robert Wood Johnson University Hospital, New Brunswick, NJ
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Correspondence to:
Christian C Toquica Gahona, Internal Medicine Department, Saint Peters University Hospital, Rutgers-Robert Wood Johnson University Hospital, New Brunswick, NJ christiantoquica@gmail.com
Publication history:
Received 17 Mar 2021
Revised 19 Jul 2021
Accepted 31 Jul 2021
Published online 07 Oct 2021
Published in print 26 Oct 2021
Gahona CCT, Raj K, Shah M, Sankaramangalam K, Shah RJ, Patel KV. Delayed pericarditis in a patient with COVID-19 pneumonia: a case report. EJMCR. 2021; 5(9): 265-269. doi:
10.24911/ejmcr/173-1615936374
Gahona CCT, Raj K, Shah M, Sankaramangalam K, Shah RJ, Patel KV. Delayed pericarditis in a patient with COVID-19 pneumonia: a case report. https://www.ejmcr.com/?mno=64857 [Access: March 29, 2024]. doi:
10.24911/ejmcr/173-1615936374
Gahona CCT, Raj K, Shah M, Sankaramangalam K, Shah RJ, Patel KV. Delayed pericarditis in a patient with COVID-19 pneumonia: a case report. EJMCR. 2021; 5(9): 265-269. doi:
10.24911/ejmcr/173-1615936374
Gahona CCT, Raj K, Shah M, Sankaramangalam K, Shah RJ, Patel KV. Delayed pericarditis in a patient with COVID-19 pneumonia: a case report. EJMCR. (2021), [cited March 29, 2024]; 5(9): 265-269. doi:
10.24911/ejmcr/173-1615936374
Gahona, C. C. T., Raj, . K., Shah, . M., Sankaramangalam, . K., Shah, . R. J. & Patel, . K. V. (2021) Delayed pericarditis in a patient with COVID-19 pneumonia: a case report. EJMCR, 5 (9), 265-269. doi:
10.24911/ejmcr/173-1615936374
Gahona, Christian C. Toquica, Kavin Raj, Monarch Shah, Kesavan Sankaramangalam, Riya J. Shah, and Keval V. Patel. 2021. Delayed pericarditis in a patient with COVID-19 pneumonia: a case report. European Journal of Medical Case Reports, 5 (9), 265-269. doi:
10.24911/ejmcr/173-1615936374
Gahona, Christian C. Toquica, Kavin Raj, Monarch Shah, Kesavan Sankaramangalam, Riya J. Shah, and Keval V. Patel. "Delayed pericarditis in a patient with COVID-19 pneumonia: a case report." European Journal of Medical Case Reports 5 (2021), 265-269. doi:
10.24911/ejmcr/173-1615936374
Gahona, Christian C. Toquica, Kavin Raj, Monarch Shah, Kesavan Sankaramangalam, Riya J. Shah, and Keval V. Patel. "Delayed pericarditis in a patient with COVID-19 pneumonia: a case report." European Journal of Medical Case Reports 5.9 (2021), 265-269. Print. doi:
10.24911/ejmcr/173-1615936374
Gahona, C. C. T., Raj, . K., Shah, . M., Sankaramangalam, . K., Shah, . R. J. & Patel, . K. V. (2021) Delayed pericarditis in a patient with COVID-19 pneumonia: a case report. European Journal of Medical Case Reports, 5 (9), 265-269. doi:
10.24911/ejmcr/173-1615936374