Coronavirus disease 2019 (Covid-19) presenting as purulent fulminant myopericarditis and cardiac tamponade: A case report and literature review

Abstract

The vast majority of patients in the ongoing coronavirus Disease 2019 (Covid-19) pandemic primarily present with severe respiratory illness. We report a Covid-19 patient who presented with findings of acute coronary syndrome and was found to have purulent fulminant myopericarditis and cardiac tamponade. We compare our case to the previously reported instances of Covid-19-associated myocarditis. Through review of the available literature, we also highlight the potential mechanisms of cardiac injury in Covid-19. We hope to increase awareness amongst clinicians about this unusual presentation of Covid-19.

Keywords: Coronavirus; Covid-19; Myocarditis; Myopericarditis; SARS-Cov-2; Tamponade.

Fig. 1

Portable chest radiograph (Antero-posterior view) showing presence of diffuse bilateral patchy opacities within lung parenchyma. The cardiac silhouette appears normal in size. An endotracheal tube is visualized (blue arrow), with the tip above the carina. An enteric tube is noted (yellow arrow), with its distal end coursing below the diaphragm. A femoral approach Swan-Ganz catheter is noted (green arrow), with its tip overlying the right pulmonary artery. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.).

Fig. 2

Echocardiographic image (subcostal view) showing large pericardial effusion (red arrow) producing cardiac tamponade and collapse of right ventricle (blue arrow). (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.).