FATAL COVID-19 COMPLICATION IN A LATIN-AMERICAN HEALTHY FEMALE

Ocasio Tapia, Josue; Cruz Rodriguez, Migdoel; Gonzalez Chaple, Joel; Roman-Velez, Neshma; Santiago, Juan; Santiago-Berrios, Michel; Vargas, Pedro

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Covid-19 is not just a respiratory virus, it can show up atypically and does not discriminate age, gender or health status. Many people have had the disease with just mild symptoms. However, symptoms can vary from as simple as flu-like illness to severe systemic disease leading to dead. CASE PRESENTATION: This is a case of a 41-year-old Latin-American female who came to the Emergency Department (ED) complaining of general malaise after arriving from Dominican Republic. Symptoms started 1.5 week, associated with myalgias, subjective fever, fatigue, dyspnea non-proportional to exertion and SOB, which progressed to chest discomfort relieved by sitting up and worsened by lying down. Physical examination was remarkable for a toxic appearing patient, hemodynamically stable on mild distress due to generalized muscle aches. Lungs were clear to auscultation. Cardiac examination revealed tachycardia without murmurs, rubs, gallops or JVD. No edema or cyanosis noted. Abdominal exam revealed diffuse moderate tenderness without peritoneal sign. Labs revealed leukocytosis with left shift, mild transaminitis, lactic acidemia and elevated cardiac troponins. COVID-19 antigen test was positive. EKG revealed sinus tachycardia with premature atrial contractions. Bedside ultrasound revealed pericardial effusion with diastolic right ventricular collapse. Patient was immediately managed with aggressive intravenous isotonic fluid. Afterwards, patient developed tachypnea, neurological and hemodynamic deterioration. Patient was endotracheally intubated and sono-guided pericardiocentesis was performed. Post-procedure cardiac sonogram revealed resolution of pericardial effusion, however poor cardiac contractility and hypotension noted for which was placed on Norepinephrine and Dobutamine Drip with improvement of hemodynamics. Despite management patient underwent cardiac arrest and died. DISCUSSION: COVID-19 infection presents with a wide variety of symptoms, which leads to a diagnostic challenge since have demonstrated to be more than a respiratory virus. This case is an example of clinically suspected myocarditis by COVID-19 virus, which shown this virus have myotropic effects. Our patient presented with predominantly with signs and symptoms of right heart dysfunction secondary to pericardial effusion complicated by suspected fulminant clinical myocarditis w/o typical changes in lung imaging. Unfortunately, patient was not stable to undergo endomyocardial biopsy or cardiac MRI. However, patient fulfilled clinical criteria for diagnosis. CONCLUSIONS: This case is an example of COVID-19 extra-pulmonary infection, as well as the importance of increasing awareness on disease prevention and vaccination. REFERENCE #1: https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-myocarditis-in-adults/abstract/1 DISCLOSURES: No relevant relationships by Migdoel Cruz Rodriguez, source=Web Response No relevant relationships by Joel Gonzalez Chaple, source=Web Response No relevant relationships by Josue Ocasio Tapia, source=Web Response No relevant relationships by Neshma Roman-Velez, source=Web Response No relevant relationships by Juan Santiago, source=Web Response No relevant relationships by Michel Santiago-Berrios, source=Web Response No relevant relationships by Pedro Vargas, source=Web Response