Observational cohort study of pericarditis associated to COVID-19 affection

Background SARS-Coronavirus-2 (COVID-19) infection is a pandemic with various clinical presentations including pericarditis which seems to be rare. Purpose The aim of this observational cohort study was to describe characteristics and management of the patients hospitalized for pericarditis secondary to COVID 19 in the Hospital of Haguenau, France. Methods We retrospectively enrolled patients admitted for pericarditis secondary to COVID 19 affection, either confirmed by a typical chest CT scan, or a positive Covid 19 PCR. Data were collected by a careful review of their medical record. Results 7 patients (4 men, 3 women) were included, with a median age of 60 and a median body mass index of 27.8 kg/m2. One of them took angiotensin II receptor antagonists, and none angiotensin converting enzyme inhibitors. Chest pain and dyspnea were the most common initial symptoms. Pericarditis were diagnosed with a median delay of 21 days after the onset of symptoms. The biology showed an inflammatory syndrome (median CRP at 104 mg/L). The troponin peak value was increased in two cases. Chest computed tomography revealed a typical lung COVID-19 affection in 4 cases and a pericardial effusion in every cases. Left ventricle ejection fraction assessed by echocardiography was normal. Two cases evolved into cardiac tamponade, which needed pericardiocentesis. One of the two cases of tamponade had a negative COVID 19 nasopharyngeal PCR and no pulmonary sign of the affection on the chest CT, but the Covid-19 PCR on pericardial fluid was positive. One patient required oxygen supply. Treatment with Colchicine was systematically initiated. Non-steroidal anti-inflammatory drugs were not introduced considering the risk of respiratory worsening. The 1-month follow-up revealed no death and a decrease of the pericardial effusion. Conclusion This study suggest a higher prevalence of COVID-19-associated pericarditis than initially presumed, with heterogeneous clinical presentations.