AN ISOLATED PLEURAL EFFUSION AS A SEQUELA OF COVID-19 INFECTION

ABSTRACT

SESSION TITLE Fellows Chest Infections Posters SESSION TYPE Fellow Case Report Posters PRESENTED ON October 18-21, 2020 INTRODUCTION: Since December 2019, the coronavirus disease 2019 (COVID-19) outbreak has resulted in widespread transmission and death. Understanding how this viral pneumonia causes acute lung injury is evolving, but it typically manifests as peripheral bilateral ground glass on chest imaging. We report a unique case of a COVID-19 patient who presented with a new isolated left pleural effusion that is likely a sequela of the infection. CASE PRESENTATION A 25-year-old female with no co-morbidities was seen in ED at another hospital for flu-like symptoms and found to have COVID-19. At that time, her chest radiograph showed hazy opacities overlying left greater than right lung lobes consistent with multifocal pneumonia. She was discharged home on doxycycline. Patient felt better following discharge but then presented to our hospital four weeks later with left sided pleuritic chest pain of two weeks duration. She denied any fever, cough, recent travel, or sick contacts. Vital signs were T 99.4 F, HR 97, BP 109/76, RR 20, and 96 % O2 saturation on room air. Physical exam was significant for decreased air entry at left lung base. A comprehensive metabolic panel, complete blood count, troponins, BNP, and LDH were within normal limits. However, D-dimer was elevated. Both chest radiograph and CT chest angiogram showed a new moderate left pleural effusion, but in addition CT showed ground glass opacities in the left upper and right lower lung lobes noted on the CT. Patient was started on empiric antibiotics. Her symptoms improved after 700 cc of serous pleural fluid was drained via a pigtail catheter. Pleural fluid analysis showed an overtly exudative fluid with protein ratio of 0.74 and LDH ratio of 3.08 with fluid LDH of 719. Other pertinent fluid analysis revealed pH 7.5, WBC 9744 with 60% neutrophils, with no organisms on gram stain or culture. Fluid cytology showed numerous acute and chronic inflammatory cells and few macrophages admixed with degenerated cells. Patient underwent repeat COVID-19 testing via the nasal swab and pleural fluid PCR, which were both negative. DISCUSSION: Pleural effusions can be related to diseases of the lungs and heart or to a systemic disease. To treat pleural effusions, it is important to determine the etiology. In this case, given the patient’s history of COVID-19 infection and exclusion of all other causes, the exudative predominantly neutrophilic pleural effusion most likely reflected a parapneumonic effusion. CONCLUSIONS: COVID-19 can present with non-specific imaging findings;however, to our knowledge, an isolated pleural effusion has not been reported in patients with COVID-19. Reference #1 McIntosh K, Hirsch Martin, Bloom A. Coronavirus disease 2019 (COVID-19) Clinical features and diagnosis. In Post T, ed. UpToDate. Waltham, Mass. UpToDate;2020. www.uptodate.com. Accessed May 31, 2020. Reference #2 Hani C et al. COVID-19 pneumonia A review of typical CT findings and differential diagnosis. Diagn Interv Imaging. 2020;101(5) 263-268. doi 10.1016/j.diii.2020.03.014 Reference #3 Bernheim A et al. Chest CT Findings in Coronavirus Disease-19 (COVID-19) Relationship to Duration of Infection. Radiology. 2020;295(3) 685-691. doi10.1148/radiol.2020200463 DISCLOSURES No relevant relationships by Sharath Bellary, source=Web Response No relevant relationships by Sudipa Chowdhury, source=Web Response No relevant relationships by William Meng, source=Web Response No relevant relationships by Richard Miller, source=Web Response No relevant relationships by SUMITANAND MISHRA, source=Web Response No relevant relationships by Rutwik Patel, source=Web Response No relevant relationships by Hari Sharma, source=Web Response