Atypical Presentation of Constrictive Pericarditis With Constrictive Physiology on Cardiac MRI.

Constrictive pericarditis (CP) is a disease primarily affecting the pericardial sac surrounding the heart. The constrictive physiology placed on the heart chambers can lead to clinical presentations mimicking heart failure and possibly primary liver disease. The diagnosis can often be missed and attributed to other etiologies until the patient undergoes extensive workup to rule out each potential etiology. Diagnosis can be delayed, leading to suboptimal outcomes and mortality rates. Here, we present a case of CP initially presenting with bilateral lower extremity and scrotal edema, initially attributed to alcoholic liver cirrhosis given the patient's history of alcohol abuse. Subsequent abdominal imaging found no evidence of cirrhosis, coupled with grossly normal echocardiogram that led to extensive workup and eventually the diagnosis of CP based on cardiac MRI. The patient later underwent pericardiectomy and made a full recovery. This case highlights the often ambiguous presentation of CP, the utility of cardiac MRI in diagnosis, and the need for specific criteria to help guide future diagnoses as imaging modalities continue to evolve.

First Manic Episode Following SARS-CoV-2 Infection.

Since the beginning of the COVID-19 pandemic, there have been reports of neuropsychiatric symptoms following infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), most notably mania and psychosis. However, despite the widely reported incidence of psychosis and mania following infection with SARS-CoV-2, a causal link between the virus and these neuropsychiatric symptoms has not been established. A myriad of confounding factors such as underlying psychiatric disorders, personal and family psychiatric histories, substance use, and treatment with steroids all have the ability to obscure a correlation between SARS-CoV-2 and subsequent psychiatric symptoms. Here we present a case of a manic episode in a 40-year-old male following a COVID-19 infection. He had no past psychiatric history, no family psychiatric history, and no history of substance use. This case is unique in that the patient lacks all these typical confounding variables. It should serve as an example of a first-time manic episode following a recent infection with SARS-CoV-2. It may contribute data to future investigations seeking to better elucidate the correlation between SARS-CoV-2 and neuropsychiatric symptoms such as mania.

Severe acquired haemophilia associated with asymptomatic SARS-CoV-2 infection.

A 65-year-old man presented with symptoms of severe subcutaneous bleeding in his arm, which led to compartment syndrome requiring fasciotomy and massive blood transfusion protocol. Medical history was significant for history of autoimmune thyroid disease. Workup revealed elevated partial thromboplastin time, decreased factor VIII levels and elevated factor VIII inhibitor levels. He was worked up for causes of acquired haemophilia A and was found to have an elevated SARS-CoV-2 antibody level. Given his negative workup for other secondary aetiologies, we suspect that the cause of his haemophilia A was from his SARS-CoV-2 infection, which has been observed previously in various case reports.