The emergence of SARS-CoV-2, the virus responsible for the COVID-19 pandemic, has significantly impacted the global landscape. While the respiratory implications of the virus are well-known, its effects on other systems, particularly the cardiovascular system, are still being uncovered. One manifestation that has garnered attention is acute pericarditis, which can lead to pericardial tamponade, a critical condition requiring immediate intervention.
In a recent case report from Narita-Tomisato Tokushukai Hospital, Chiba-Japan, Tokyo Medical University Hospital-Japan, and Asahi General Hospital-Japan, a rare instance of post-COVID subacute hemorrhagic pericardial tamponade is explored. The patient initially presented with acute osteomyelitis of the toes, which was successfully treated. However, he later contracted mild COVID-19 without pneumonia and developed hemorrhagic pericardial tamponade. The diagnosis was initially unclear, as cytological analysis of the pericardial fluid raised concerns about malignancy. However, further investigations revealed reactive atypia in mesothelial cells, diverting the diagnosis from cancer. A biopsy examination also showed non-caseating granulomas in the lymph nodes, ruling out malignancy. The temporal association between the preceding COVID-19 infection and the occurrence of subacute pericardial tamponade led to the diagnosis of COVID-19-associated acute pericarditis. Treatment with anti-inflammatory agents and corticosteroids resulted in the resolution of symptoms.
This case serves as the first report of COVID-19-associated pericarditis mimicking malignancy, highlighting the diverse presentations associated with the virus. It also raises concerns about the limited efficacy of early COVID-19 treatment in preventing pericardial involvement. The case emphasizes the importance of advanced imaging, such as T2-weighted cardiac MRI, in diagnosing pericarditis when traditional criteria are inconclusive. Despite theoretical concerns, the management of COVID-19-associated hemorrhagic pericarditis with ibuprofen and corticosteroids proved effective in this case.
The study also delves into potential mechanisms underlying COVID-19-associated hemorrhagic pericarditis, discussing the direct impact of the virus on cardiovascular tissues, hyperinflammatory responses, and dysregulated endothelial cell/pericyte interactions. This case highlights the need for clinicians to consider diverse presentations and carefully evaluate the cytomorphological and histological features after COVID-19 infection.
As the world continues to grapple with the ongoing pandemic, in-depth analyses like this provide valuable insights into the complexities of COVID-19-related complications. Continuous research and vigilance are crucial in understanding the various ways in which SARS-CoV-2 can impact the human body. Each case contributes to a deeper understanding of the virus and its implications on human health, ultimately improving diagnostics, treatment strategies, and patient care.