Pericardial and neurological localization of persistentSARS-CoV2 infection: The case of a patient with coexistenceof pericarditis and Guillain-Barrè Syndrome

ABSTRACT

Background: SARS-CoV2 infection is frequently associated withcardiovascular and neurological manifestations, but pericardiumand Peripheral Nervous System (PNS) are rarely involved. Case Report A 61 year-old man was admitted in March 2020 tothe Covid Unit of Miulli Hospital in Acquaviva delle Fonti (Bari) forfever, cough and oropharyngeal swab positive for SARS-CoV2. Hiscomorbidities were hypertension and obesity. Laboratory testsshowed high levels of inflammatory proteins and the presence ofIgM for Chlamydia. Computed Tomography (CT) documented pneumonia with bilateral peripheral and central ground glass opacitiesand little areas of consolidation. He was treated with hydroxychloroquine, ritonavir and quinolone. Despite an early clinical andradiological remission, the swab became negative after twomonths. In May the patient returned for chest pain and fever.SARS-CoV2 swab resulted positive again. Transthoracic Echocardiography (TTE) documented mild pericardial effusion that reducedafter ibuprofen. In June the patient presented to the EmergencyDepartment for weekness in both legs and arms, severe fatigueand evidence of simmetric iporeflexia. He tested negative forSARS-CoV2. Cerebrospinal Fluid (CSF) and Electromyography(EMG) were diagnostic for Guillain-Barrè Syndrome (GBS), AcuteInflammatory Demyelinating Polyradiculoneuropathy (AIDP) type,so we started infusion of human immunoglobulins. Conclusions: The persistence of SARS-CoV2 viral RNA induces anabnormal immunological activation that may damage pericardiumand Peripheral Nervous System (PNS).