David Kaltman, MD
University of Maryland School of Medicine
Washington, District of Columbia
Disclosure information not submitted.
Steven Cassady, MD
Assistant Professor, Division of Pulmonary and Critical Care Medicine
University of Maryland School of Medicine, United States
Disclosure information not submitted.
Title: Atypical Inflammatory Phenomena in COVID19: Pleural Effusion, Lung Abscess, and Pericardial Effusion
Case Report Body:
Introduction:
Previous reports describe various inflammatory conditions associated with COVID-19 infection. We present a case with a multitude of inflammatory manifestations. Underlying predisposition to autoimmunity may play a pathophysiologic role.
Description:
A 33-year-old woman with no significant past medical history presented in May 2021 with shortness of breath. PCR testing for SARS-CoV-2 was positive. She underwent CT angiography of the chest, notable for no acute pulmonary emboli, scattered ground glass opacities, and a dense right middle lobe consolidation with cavitation. Testing for tuberculosis was negative. She was treated with a three-week course of antibiotics and received only symptomatic treatment for COVID-19 given lack of hypoxia. After discharge, serum fungal markers returned as elevated. Six weeks later she presented again with cough and progressive dyspnea and was now found to have a right middle lobe abscess with loculated pleural effusion and adjacent moderate circumferential pericardial effusion. Echocardiography was not consistent with cardiac tamponade. She was started on broad spectrum antibiotics and a small-bore chest tube was inserted in the right anterior chest. Bronchoscopy with bronchoalveolar lavage was also pursued. Output from the chest tube was minimal despite use of intrapleural lytics and these studies did not yield a specific microbiologic diagnosis. Repeat fungal markers were normal but further testing revealed a positive speckled ANA at 1:320. Additional rheumatologic testing was non-diagnostic. Pericardial drainage was deferred given clinical stability. Repeat imaging after 10 days of antibiotics demonstrated slight improvement in the right middle lobe consolidation, improvement of the pleural effusion, and complete resolution of the pericardial effusion, suggesting bacterial superinfection. The chest tube was removed, and the patient was discharged on a prolonged course of antibiotics.
Discussion:
COVID-19 can induce autoimmune-like responses or may be a trigger in patients with underlying predisposition to autoimmunity. Pleural and pericardial effusions are uncommon in COVID-19 patients who are not severely ill. To our knowledge, this is the first case reporting co-occurrence of pleural and pericardial effusions and lung abscess as complications of COVID-19 infection.