Hemorrhagic pericardial effusion leading to cardiac tamponade, as presenting feature of COVID-19 in a young man: a case report

Background Coronavirus disease 2019(COVID-19) is an acute respiratory illness, caused by Severe Acute Respiratory Syndrome Coronavirus2 (SARS-COV2) which quickly grew to a pandemic in late 2019 and led to substantial public health problems. Among the extrapulmonary manifestations reported, cardiovas-cular implications are remarkable as they can be potentially lethal. There have been rare reports of pericardial involvement, despite the pronounced cardiovascular complications including acute myocardial injury, myo-carditis, arrhythmia, cardiogenic shock and venous thromboembolism. Herein, we reported a young man with cardiac tamponade as the presenting feature of COVID-19.Case summary An otherwise healthy 28-year-old man, was admitted with pleuritic chest pain and shortness of breath and was diagnosed with COVID-19 as-sociated cardiac tamponade. Emergency pericardiocentesis yielded large amount of hemorrhagic pericardial effusion which resulted in symptom relief. He was successfully treated with pericardiocentesis followed by an-ti-viral and anti-inflammatory medications and remained asymptomatic in 1-month follow-up.Conclusion We highlight this case to mention that “hemorrhagic” cardiac tamponade can be a life-threatening complication of COVID-19, which can be treated if diagnosed early. Therefore, clinicians should be fully aware of this cardiac complication to consider in deteriorating COVID-19 patients. Abbreviation list COVID-19=Coronavirus Disease 2019 SARS-COV2=Severe Acute Respiratory Syndrome Coronavirus 2 LVEF=Left Ventricular Ejection Fraction RR=Reference Range LDH=Lactate Dehydrogenase CPK=Creatine Phosphokinase CK-MB=Creatine Kinase-Myoglobin Binding RT-PCR= Reverse Transcription Polymerase Chain Reaction cTNI=Cardiac Troponin I NT-pro-BNP=N-Terminal pro-B-type Natriuretic Peptide What is importantHemorrhagic cardiac tamponade should be considered as complication or presenting feature of COVID-19 infection. In this critical situation, intensive treatment must be initiated as soon as possible to reduce the mortality rate and avoid later complications. (www.actabiomedica.it)