Acute Pericarditis in ESRD due to COVID-19 Despite Vaccination

ABSTRACT

Introduction: - Myocarditis, cardiomyopathy, and heart failure;common cardiac manifestations of Coronavirus infectious disease (COVID-19).1-3 - Acute pericarditis is rare.4 - We report a case of a new-onset pericardial rub diagnosed as acute pericarditis due to COVID-19 in a patient with end-stage renal disease (ESRD) despite vaccination. Case Description - A 61-year-old male with a history of chronic kidney disease stage 5 (CKD 5) approaching dialysis, status post renal transplant twice (first in 1997 and second in 2010) presented with dyspnea of a few days' duration. - Medications amlodipine, atorvastatin, calcitriol, clonidine patch, hydralazine, sevelamer, tacrolimus, and tamsulosin. - Physical examination 2+ pitting edema and rales over bilateral lung fields. - Laboratory tests Blood urea nitrogen (BUN) and Creatinine (Cr) of 154/13.6, respectively. Initial COVID-19 serologies were negative. - Electrocardiogram (EKG) and echocardiogram (ECHO) at admission were unremarkable. - Received seven hemodialysis sessions that improved his symptoms. - Subsequently, he spiked a fever with a recurrence of dyspnea and pleuritic chest pain. - Auscultation New onset pericardial rub. - Laboratory test BUN/Cr of 54/5.3. Tested positive for COVID-19. - Repeat ECHO Pericarditis and moderate-sized pericardial effusion with normal left ventricular systolic function and ejection fraction. - Treated with heparin-free intensive hemodialysis and colchicine. Discussion(s) - Acute pericarditis presentation;Two or more of the following symptoms chest pain, friction rub, diffuse ST-elevations, PR depressions on EKG, and new or worsening pericardial effusion.5 - Can lead to cardiac tamponade if left untreated.6 - In ESRD, important to consider differential diagnoses of pericarditis;uremia, and fluid overload causing effusion. Due to the recent pandemic, COVID-19 must be taken into consideration irrespective of vaccination status.