key: cord-273930-4asx0dq3
authors: Ortiz-Martínez, Yeimer; Cabeza-Ruiz, Luis Daniel; Vásquez-Lozano, Sergio Humberto; Villamil-Gómez, Wilmer E.; Rodriguez-Morales, Alfonso J.
title: Pericarditis in a young internal medicine resident with COVID-19 in Colombia
date: 2020-08-28
journal: Travel Med Infect Dis
DOI: 10.1016/j.tmaid.2020.101863
sha: 
doc_id: 273930
cord_uid: 4asx0dq3

nan

patients [1, 2] , especially in developing countries such as Colombia. As previously stated [1] COVID-19 may also present in them with a broad and changing spectrum of clinical disease, including cardiovascular conditions, as is the case of the pericarditis.

The patient, a 25-year-old male, with no past medical history, first-year internal medicine resident attending patients in the emergency department in a reference public tertiary hospital in Bucaramanga, Santander, Northeast Colombia, wearing all personal protective equipment (PPE) and complying the protection policies and procedures implemented in his hospital during the early COVID-19 pandemic.

On July 19, 2020, the physician presented with myalgias, arthralgias and diarrhoea (watery stools, with no blood or mucus, from five to six episodes per day). However, with no fever or respiratory symptoms, he self-medicated with paracetamol and probiotics. On July 21, he additionally presented with fever (38,6ºC) and nausea. The same day reported his clinical condition to the hospital and started home isolation, a nasopharyngeal swab for SARS-CoV-2 test (Logix Smart, IVD/CE/FDA) was done at home. His initial symptoms persisted, the body temperature varied between 38 and 38.6ºC, oxygen saturation >95%, and the myalgias and With these findings, the diagnosis of acute pericarditis was made, meeting 2 of 4 criteria: pericarditic chest pain and new pericardial effusion. At that moment, treatment was started with colchicine 0.5 mg OD, ibuprofen 800 mg three times daily. During his hospital course, the patient presented severe chest pain that was difficult to relieve, requiring high doses of morphine, with the subsequent change to oxycodone with clinical improvement. After that, lactate levels were normalized, electrocardiograms and serial troponin tests were performed without changes.

He was discharged home in stable condition with colchicine 0.5 mg two times daily, ibuprofen 800 mg three times daily and acetaminophen plus codeine with plans for a gradual taper following complete resolution of symptoms.

Colombia is currently on the top ten of countries with the highest cumulative cases of COVID-19, with 376,870 cases (August 8, 2020). Despite the use of PPE by the HCW, including those on training, as the case described, SARS-CoV-2 infection risk is evident, and transmission may occur.

Our case also presented with, a still considered novel, clinical manifestation of COVID-19.

Although cardiovascular conditions have been reported widely in COVID-19 so far [3, 4] , there is a lack of cases presenting with pericarditis, especially without other significant complications.

Multiple viruses can lead to the development of pericarditis [5] . In the case of COVID-19, this consequence requires more detailed studies to understand their pathophysiology, but especially their clinical course and implications. As the pandemic increases, early detection and suspicion of cases, based on broader clinical findings, would be useful, to aid diagnosis, in addition to the confirmation by the rRT-PCR [1, 6] . Pericarditis is not frequent in the context of common cold and flu, then, an increase in this finding, in the COVID-19 context, make this case relevant. 

A conflicting interest exists when professional judgement concerning a primary interest (such as patient's welfare or the validity of research) may be influenced by a secondary interest (such as financial gain or personal rivalry). It may arise for the authors when they have financial interest that may influence their interpretation of their results or those of others. Examples of potential conflicts of interest include employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/registrations, and grants or other funding.

Nothing to declare.

All sources of funding should also be acknowledged and you should declare any involvement of study sponsors in the study design; collection, analysis and interpretation of data; the writing of the manuscript; the decision to submit the manuscript for publication. If the study sponsors had no such involvement, this should be stated.

None.

Signature (a scanned signature is acceptable, Print name but each author must sign)

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