Assuntos
COVID-19 , Miocardite , Pericardite , Viroses , COVID-19/prevenção & controle , Vacinas contra COVID-19/efeitos adversos , Humanos , Injeções Intravenosas , Miocardite/tratamento farmacológico , Miocardite/virologia , Pericardite/tratamento farmacológico , Pericardite/virologia , RNA Mensageiro/uso terapêutico , Vacinas Sintéticas , Vacinas de mRNARESUMO
INTRODUCTION: In the last few months, some pediatric cases with neurological and neuroradiological pictures related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections have been reported, often associated with multisystem inflammatory syndrome (MIS-C). The most frequently encountered pediatric neurological complications seem to be postinfectious immune-mediated acute disseminated encephalomyelitis (ADEM)-like changes of the brain, myelitis, neural enhancement, and splenial lesions. Concomitant neurological and cardiac involvement has been reported only in MIS-C, although specific clinical details are often not fully available. METHODS: In this case report, a very young child infected with SARs-CoV-2 and diagnosed as longitudinal extensive transverse myelitis with concomitant myo-pericarditis is presented. RESULTS: A previously healthy 7-month-old girl presented with abrupt onset of generalized weakness with inability to sit up. She had had mild respiratory symptoms 1 week earlier. Spinal magnetic resonance imaging (MRI) showed a T2-hyperintense intramedullary lesion extending from C4 to T2, compatible with acute longitudinally extensive transverse myelitis (LETM). Cerebrospinal fluid analysis was negative.Echocardiography and blood tests were suggestive for myo-pericarditis. Real time polymerase chain reaction for SARS-CoV-2 on nasopharyngeal swab sample tested positive. She was promptly treated with high dose of steroids and immunoglobulin with satisfactory clinical response. CONCLUSION: To the evolving literature of neurological complications of SARs-CoV-2 infection, we add the youngest patient described to date with isolated LETM and concomitant cardiac involvement. Our case suggests that clinicians should be aware of this association, although difficult to recognize in infants. Practitioners are encouraged to consider aggressive first-line immunotherapies with the final aim to prevent permanent disability.
Assuntos
COVID-19 , Mielite Transversa , Miocardite , Pericardite , COVID-19/complicações , Feminino , Humanos , Lactente , Imageamento por Ressonância Magnética , Mielite Transversa/diagnóstico por imagem , Mielite Transversa/virologia , Miocardite/diagnóstico por imagem , Miocardite/virologia , Pericardite/diagnóstico por imagem , Pericardite/virologiaRESUMO
With the emerging success of the COVID-19 vaccination programs, the incidence of acute COVID-19 will decrease. However, given the high number of people who contracted SARS-CoV-2 infection and recovered, we will be faced with a significant number of patients with persistent symptoms even months after their COVID-19 infection. In this setting, long COVID and its cardiovascular manifestations, including pericarditis, need to become a top priority for healthcare systems as a new chronic disease process. Concerning the relationship between COVID-19 and pericardial diseases, pericarditis appears to be common in the acute infection but rare in the postacute period, while small pericardial effusions may be relatively common in the postacute period of COVID-19. Here, we reported a series of 7 patients developing pericarditis after a median of 20 days from clinical and virological recovery from SARS-CoV-2 infection. We excluded specific identifiable causes of pericarditis, hence we speculate that these cases can be contextualized within the clinical spectrum of long COVID. All our patients were treated with a combination of colchicine and either ASA or NSAIDs, but four of them did not achieve a clinical response. When switched to glucocorticoids, these four patients recovered with no recurrence during drug tapering. Based on this observation and on the latency of pericarditis occurrence (a median of 20 days after a negative nasopharyngeal swab), could be suggested that post-COVID pericarditis may be linked to ongoing inflammation sustained by the persistence of viral nucleic acid without virus replication in the pericardium. Therefore, glucocorticoids may be a suitable treatment option in patients not responding or intolerant to conventional therapy and who require to counteract the pericardial inflammatory component rather than direct an acute viral injury to the pericardial tissue.
Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , COVID-19/complicações , Glucocorticoides/uso terapêutico , Pericardite/tratamento farmacológico , Idoso , COVID-19/patologia , Colchicina/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/patologia , Pericardite/patologia , Pericardite/virologia , Pericárdio/patologia , Pericárdio/virologia , SARS-CoV-2 , Síndrome de COVID-19 Pós-Aguda , Tratamento Farmacológico da COVID-19Assuntos
Fibrilação Atrial/epidemiologia , COVID-19/complicações , Cardiomiopatias/epidemiologia , Insuficiência Cardíaca/epidemiologia , Pericardite/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/imunologia , Fibrilação Atrial/virologia , Austrália/epidemiologia , COVID-19/imunologia , COVID-19/terapia , COVID-19/virologia , Cardiomiopatias/imunologia , Cardiomiopatias/virologia , Feminino , Insuficiência Cardíaca/imunologia , Insuficiência Cardíaca/virologia , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pericardite/imunologia , Pericardite/virologia , Estudos Prospectivos , Sistema de Registros/estatística & dados numéricos , SARS-CoV-2/imunologia , SARS-CoV-2/patogenicidadeRESUMO
BACKGROUND: The pathogenesis of the COVID19 pandemic, that has killed one million nine hundred people and infected more the 90 million until end of 2020, has been studied by many researchers. Here, we try to explain its biological behavior based on our recent autopsy information and review of literature. METHODS: In this study, patients with a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) result were considered eligible for enrollment. Histopathological examinations were done on 13 people who were hospitalized in Afzalipour hospital, Kerman, Iran. Clinical and laboratory data were reviewed. Tissue examination was done by light microscopy, immunohistochemistry and electron microscopy. RESULTS: The most frequent co-morbidity in the patients was cardiovascular disease. The common initial symptoms of COVID-19 infection were dyspnea and cough. In all cases, the number of white blood cells was higher than the normal range. Common histopathological findings were variable degrees of vasculitis as degenerative to necrotic changes of endothelium and trafficking of inflammatory cells in the vessel wall with fibrinoid necrosis. Tissue damage included interstitial acute inflammatory cells reaction with degenerative to necrotic changes of the parenchymal cells. CD34 and Factor VIII immunohistochemistry staining showed endothelial cell degeneration to necrosis at the vessel wall and infiltration by inflammatory cells. Electron microscopic features confirmed the degenerative damages in the endothelial cells. CONCLUSION: Our histopathological studies suggest that the main focus of the viral damage is the endothelial cells (endotheliopathica) in involved organs. Also, our findings suggest that degeneration of leukocytes occurs at the site of inflammation and release of cytokines (leukocytoclastica) resulting in a cytokine storm.
Assuntos
COVID-19/complicações , COVID-19/patologia , Células Endoteliais/patologia , Leucócitos/patologia , Adulto , Idoso , COVID-19/metabolismo , Estudos de Coortes , Citocinas/metabolismo , Feminino , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Pericardite/patologia , Pericardite/virologia , Dermatopatias/patologia , Dermatopatias/virologiaRESUMO
We report COVID-19 multisystemic inflammatory syndrome in an adult patient with an atypical presentation (mild abdominal pain) and a negative (repeated) reverse transcriptase-PCR, in the absence of lung involvement on lung ultrasound. In this case, focused cardiac ultrasound revealed signs of myopericarditis and enabled us to focus on the problem that was putting our patient in a perilous situation, with a quick, non-time-consuming and easy-to-access technique. Serology test was performed and SARS-CoV-2 infection was confirmed more than a week after admission to the coronary unit. As the patient had a general good appearance, the potential implications of missing this diagnosis could have been fatal.
Assuntos
COVID-19/diagnóstico , Miocardite/diagnóstico por imagem , Pericardite/diagnóstico por imagem , Síndrome de Resposta Inflamatória Sistêmica/virologia , Dor Abdominal , Adulto , COVID-19/complicações , Teste Sorológico para COVID-19 , Ecocardiografia , Humanos , Pulmão/diagnóstico por imagem , Masculino , Miocardite/virologia , Pericardite/virologia , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , UltrassonografiaRESUMO
Children and adolescents with severe acute respiratory syndrome coronavirus 2 infection usually have a milder illness, lower mortality rates and may manifest different clinical entities compared with adults. Acute effusive pericarditis is a rare clinical manifestation in patients with COVID-19, especially among those without concurrent pulmonary disease or myocardial injury. We present 2 cases of acute pericarditis, in the absence of initial respiratory or other symptoms, in adolescents with COVID-19.
Assuntos
COVID-19/diagnóstico por imagem , Derrame Pericárdico/diagnóstico por imagem , Pericardite/diagnóstico por imagem , SARS-CoV-2/isolamento & purificação , Adolescente , COVID-19/complicações , COVID-19/patologia , COVID-19/virologia , Feminino , Humanos , Pulmão/patologia , Pulmão/virologia , Masculino , Derrame Pericárdico/etiologia , Derrame Pericárdico/patologia , Derrame Pericárdico/virologia , Pericardite/etiologia , Pericardite/patologia , Pericardite/virologiaRESUMO
Vertical transmission of SARS-CoV-2 has already been described, while clinical consequences to the fetus are still under investigation. This article reports a case of systemic fetal inflammatory response and pericardial effusion. As far as is known, this is the first case of fetal/neonatal cardiac complications related to SARS-CoV-2 infection.
Assuntos
COVID-19/transmissão , Transmissão Vertical de Doenças Infecciosas , Derrame Pericárdico/virologia , Pericardite/virologia , Complicações Infecciosas na Gravidez , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Adulto , COVID-19/diagnóstico , Teste de Ácido Nucleico para COVID-19 , Feminino , Humanos , Recém-Nascido , Gravidez , SARS-CoV-2RESUMO
Severe acute respiratory syndrome coronavirus-2 causes the clinical syndrome of coronavirus disease of 2019 (COVID-19) which has become a global pandemic resulting in significant morbidity and mortality. While the virus primarily affects the respiratory system, it also causes a wide variety of complex cardiac manifestations such as acute myopericarditis, acute coronary syndrome, congested heart failure, cardiogenic shock and cardiac arrhythmias. There are numerous proposed mechanisms of cardiac injury, including direct cellular injury, pro-inflammatory cytokine storm, myocardial oxygen-demand mismatch, and systemic inflammation causing multi-organ failure. Additionally, medications commonly used to treat COVID-19 patients have various cardiovascular side effects. We aim to provide a succinct review about the pathophysiology and cardiac manifestations of COVID-19, as well as treatment considerations and the various adaptations made to the current healthcare structure as a result of the pandemic.
Assuntos
Síndrome Coronariana Aguda/terapia , Arritmias Cardíacas/terapia , COVID-19/terapia , Insuficiência Cardíaca/terapia , Pandemias , Pericardite/terapia , Choque Cardiogênico/terapia , Síndrome Coronariana Aguda/epidemiologia , Síndrome Coronariana Aguda/patologia , Síndrome Coronariana Aguda/virologia , Antivirais/administração & dosagem , Antivirais/efeitos adversos , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/patologia , Arritmias Cardíacas/virologia , Biomarcadores/análise , COVID-19/epidemiologia , COVID-19/patologia , COVID-19/virologia , Cateterismo Cardíaco/métodos , Comorbidade , Gerenciamento Clínico , Glucocorticoides/administração & dosagem , Glucocorticoides/efeitos adversos , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/patologia , Insuficiência Cardíaca/virologia , Hospitalização , Humanos , Fatores Imunológicos/administração & dosagem , Fatores Imunológicos/efeitos adversos , Pericardite/epidemiologia , Pericardite/patologia , Pericardite/virologia , Fatores de Risco , SARS-CoV-2/patogenicidade , Índice de Gravidade de Doença , Choque Cardiogênico/epidemiologia , Choque Cardiogênico/patologia , Choque Cardiogênico/virologia , Texas/epidemiologiaRESUMO
As the coronavirus disease 2019 (COVID-19) pandemic is ongoing and new variants of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) are emerging, there is an urgent need for vaccines to protect individuals at high risk for complications and to potentially control disease outbreaks by herd immunity. Surveillance of rare safety issues related to these vaccines is progressing, since more granular data emerge about adverse events of SARS-CoV-2 vaccines during post-marketing surveillance. Varicella zoster virus (VZV), Epstein-Barr virus (EBV) and cytomegalovirus (CMV) reactivation has already been reported in COVID-19 patients. In addition, adverse events after SARS-CoV-2 mRNA vaccination have also been in the context of varicella zoster virus (VZV) reactivation and directly associated with the mRNA vaccine. We present the first case of CMV reactivation and pericarditis in temporal association with SARS-CoV-2 vaccination, particularly adenovirus-based DNA vector vaccine ChAdOx1 nCoV-19 against SARS-CoV-2. After initiation of antiviral therapy with oral valganciclovir, CMV viremia disappeared and clinical symptoms rapidly improved. Since huge vaccination programs are ongoing worldwide, post-marketing surveillance systems must be in place to assess vaccine safety that is important for the detection of any events. In the context of the hundreds of millions of individuals to be vaccinated against SARS-CoV-2, a potential causal association with CMV reactivation may result in a considerable number of cases with potentially severe complications.
Assuntos
ChAdOx1 nCoV-19/efeitos adversos , Citomegalovirus/efeitos dos fármacos , Pericardite/induzido quimicamente , SARS-CoV-2/imunologia , Ativação Viral/efeitos dos fármacos , Idoso , Antivirais/uso terapêutico , COVID-19/prevenção & controle , Citomegalovirus/fisiologia , Infecções por Citomegalovirus/induzido quimicamente , Infecções por Citomegalovirus/tratamento farmacológico , Infecções por Citomegalovirus/virologia , Feminino , Humanos , Pericardite/tratamento farmacológico , Pericardite/virologia , Resultado do Tratamento , Valganciclovir/uso terapêutico , Viremia/induzido quimicamente , Viremia/tratamento farmacológico , Viremia/virologiaRESUMO
We present the case of a 51-year-old patient with acute pericarditis as the dominant manifestation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The patient was admitted to the emergency department during a coronavirus disease 2019 (COVID-19) outbreak with a suspected ST-elevation myocardial infarction. A coronary angiogram was normal. Real-time reverse transcriptase PCR for the detection of nucleic acid from SARS-CoV-2 in a nasopharyngeal swab was positive. Laboratory tests revealed an increased white blood cell count, with neutrophilia and lymphocytopenia, elevated level of C-reactive protein, borderline elevated erythrocyte sedimentation rate, and slightly elevated interleukin 6. Echocardiography showed a hyperechogenic pericardium posterolaterally with minimal localized pericardial effusion. A chest computed tomography scan showed a small zone of ground-glass opacity in the right lower lobe (classified as CO-RADS 3). In patients with chest pain, ST elevation on electrocardiogram, a normal coronary angiogram, and suspected COVID-19, we should think of pericarditis as an unusual presentation of SARS-CoV-2 infection.
Assuntos
COVID-19/diagnóstico , Pericardite/diagnóstico , Pericardite/virologia , SARS-CoV-2/fisiologia , COVID-19/complicações , COVID-19/diagnóstico por imagem , COVID-19/virologia , Ecocardiografia , Eletrocardiografia , Hospitalização , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pericardite/complicações , Pericardite/diagnóstico por imagem , Pneumonia Viral/diagnóstico , SARS-CoV-2/genética , SARS-CoV-2/isolamento & purificação , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: This case report demonstrates pericardial effusion, acute pericarditis, and cardiac tamponade in an otherwise healthy woman who had a positive test result for coronavirus disease 2019. Few case reports have been documented on patients with this presentation, and it is important to share novel presentations of the disease as they are discovered. CASE PRESENTATION: A Caucasian patient with coronavirus disease 2019 returned to the emergency department of our hospital 2 days after her initial visit with worsening chest pain and shortness of breath. Imaging revealed new pericardial effusion since the previous visit. The patient became hypotensive, was taken for pericardial window for cardiac tamponade with a drain placed, and was treated for acute pericarditis. CONCLUSION: Much is still unknown about the implications of coronavirus disease 2019. With the novel coronavirus disease 2019 pandemic, research is still in process, and we are slowly learning about new signs and symptoms of the disease. This case report documents a lesser-known presentation of a patient with coronavirus disease 2019 and will help to further understanding of a rare presentation.
Assuntos
Tamponamento Cardíaco/virologia , Infecções por Coronavirus/complicações , Derrame Pericárdico/virologia , Técnicas de Janela Pericárdica , Pericardite/virologia , Pneumonia Viral/complicações , Adulto , Betacoronavirus , COVID-19 , Dor no Peito , Feminino , Humanos , Pandemias , SARS-CoV-2RESUMO
Despite SARS-CoV-19 infection has a stereotypical clinical picture, isolated cases with unusual manifestations have been reported, some of them being well-known to be triggered by viral infections. However, the real frequency in COVID-19 is unknown. Analysing data of 63 822 COVID patients attending 50 Spanish emergency department (ED) during the COVID outbreak, before hospitalisation, we report frequencies of (myo)pericarditis (0.71), meningoencephalitis (0.25), Guillain-Barré syndrome (0.13), acute pancreatitis (0.71) and spontaneous pneumothorax (0.57). Compared with general ED population, COVID patients developed more frequently Guillain-Barré syndrome (odds ratio (OR) 4.55, 95% confidence interval (CI) 2.09-9.90), spontaneous pneumothorax (OR 1.98, 95% CI 1.40-2.79) and (myo)pericarditis (OR 1.45, 95% CI 1.07-1.97), but less frequently pancreatitis (OR 0.44, 95% CI 0.33-0.60).
Assuntos
Infecções por Coronavirus/complicações , Síndrome de Guillain-Barré/complicações , Miocardite/complicações , Pancreatite/complicações , Pericardite/complicações , Pneumonia Viral/complicações , Pneumotórax/complicações , Betacoronavirus , COVID-19 , Síndrome de Guillain-Barré/virologia , Humanos , Miocardite/virologia , Pancreatite/virologia , Pandemias , Pericardite/virologia , Pneumotórax/virologia , SARS-CoV-2 , Espanha/epidemiologiaRESUMO
The COVID-19 pandemic is a highly contagious viral illness which conventionally manifests primarily with respiratory symptoms. We report a case whose first manifestation of COVID-19 was pericarditis, in the absence of respiratory symptoms, without any serious complications. Cardiac involvement in various forms is possible in COVID-19. We present a case where pericarditis, in the absence of the classic COVID-19 signs or symptoms, is the only evident manifestation of the disease. This case highlights an atypical presentation of COVID-19 and the need for a high index of suspicion to allow early diagnosis and limit spread by isolation.