COVID-19 associated respiratory failure complicating a pericardial effusion in a patient with sideroblastic anemia

Abstract

Background: COVID-19 disease has been associated with several cardiovascular complications that rarely occur in the acute phase of the disease.

Case report: A 13-year-old pediatric patient with congenital sideroblastic anemia associated with YARS2 mutation presenting with COVID-19 infection and worsening pericardial effusion followed by a respiratory failure refractory to supplemental oxygen therapy leading to cardiac arrest.

Discussion: This case highlights the rapid deterioration that can occur in children with serious hematologic disorders in the context of COVID-19 especially when complicated with pericardial effusion.

Conclusion: The importance of pericardiocentesis early in order to allow better ventilation in any significant pericardial effusion case associated with COVID-19 infection and the need for prompt care escalation to centers where ECMO is available.

Keywords: COVID-19; ECMO; Pericardial effusion; Sideroblastic anemia; YARS2.

Fig. 1

CT chest: Moderate pericardial effusion reaching a maximal thickness of 3 cm, atelectatic changes at the left base associated with lobular mosaic pattern of attenuation at the left upper lobe.

Fig. 2

CXR: Complete whiteout of the left hemithorax, limited pulmonary expansion on the right right-sided pleural effusion filling the fissure with underlying segmental atelectasis.

Fig. 3

CT chest: Marked Dilatation of the main pulmonary trunk; Interval circumferential increase in the size of pericardial effusion reaching 34 mm in maximal thickness.