冠状病毒病(COVID-19)相关的急性心包炎最近因其与心包填塞(PT)相关的高频率而备受关注,显示预后不良。然而,在非特异性体征和症状的病例中,早期诊断和治疗仍然具有挑战性.
一名64岁男子因急性脚趾骨髓炎入院,并接受了抗菌药物治疗。入院三天后,患者出现轻度COVID-19,无肺炎,为此启动了早期抗COVID-19药物。然而,2周后,患者因急性心包炎而出现出血性PT,心脏磁共振证实了这一点,需要紧急心包穿刺术.尽管对出血性心包液的细胞学分析强烈提示腺癌,非典型细胞最终被证明是具有反应性异型性的间皮细胞。此外,影像学上2-[18F]-氟-2-脱氧-D-葡萄糖异常积聚的淋巴结肿大提示恶性肿瘤。然而,活检显示淋巴结有多个非干酪样肉芽肿,不太可能是由于恶性肿瘤。最终,之前的COVID-19与亚急性PT发生的时间关联没有其他可识别的原因,导致最终诊断为COVID-19相关性急性心包炎.抗炎和皮质类固醇治疗,患者的症状涉及心包结构和功能,随着受影响的淋巴结肿大的改善,完全缓解。
■我们遇到一例COVID-19相关性急性心包炎,表现出血性PT的独特病例。该病例强调了即使在接受早期治疗的轻度COVID-19患者中,迟发性心包受累的残余风险,并认识到COVID-19可能引起各种细胞形态学和组织学特征。此外,应强调将这种罕见实体视为出血性心包积液的原因的重要性.
UNASSIGNED: Coronavirus disease (COVID-19)-associated acute pericarditis has recently received much attention owing to its high frequency associated with pericardial tamponade (PT), showing unfavorable prognosis. However, early diagnosis and treatment remain challenging in cases of non-specific signs and symptoms.
UNASSIGNED: A 64-year-old man was admitted to our hospital for acute osteomyelitis of the toes and was properly treated with antimicrobial agents. Three days after admission, the patient developed mild COVID-19 without pneumonia, for which early anti-COVID-19 agents were initiated. Nevertheless, the patient developed hemorrhagic PT due to acute pericarditis 2 weeks later, which was confirmed by cardiac magnetic resonance, requiring an urgent pericardiocentesis. Although cytological analysis of the hemorrhagic pericardial fluid strongly suggested adenocarcinoma, the atypical cells were eventually proven to be mesothelial cells with reactive atypia. Furthermore, lymph nodes swelling with abnormal 2-[18F]-fluoro-2-deoxy-D-glucose accumulation on imaging were suggestive of malignancy. However, biopsy examination revealed multiple non-caseating granulomas in the lymph node, unlikely due to malignancy. Eventually, the temporal association of the preceding COVID-19 with the occurrence of subacute PT without other identifiable cause led to a final diagnosis of COVID-19-associated acute pericarditis. With anti-inflammatory and corticosteroids treatment, the patient\'s symptoms involving the pericardial structure and function were completely resolved along with improvements in size of the affected lymphadenopathies.
UNASSIGNED: We encountered a unique case of COVID-19-associated acute pericarditis exhibiting hemorrhagic PT. This case underscores the residual risk of delayed pericardial involvement even in patients with mild COVID-19 who receive early treatment, and the recognition that COVID-19 may cause various cytomorphological and histological features. Additionally, the importance of considering this rare entity as a cause of hemorrhagic pericardial effusions should be highlighted.