A 45-year-old man was admitted with a fever that lasted for 2 weeks, dyspnea, and pleuritic chest pain continued for 1 week. Vital signs were as follows: body temperature = 38.5°C, systolic blood pressure = 100/70 mmHg, heart rate = 90/min and, O2 saturation = 85% without oxygenation (90% with nasal oxygen therapy). The ECG showed sinus tachycardia, no significant changes in the ST-segment, low-voltage waves in the limb leads, and QRS alternans. The TTE revealed LVEF of 45%, normal LV size and function without regional wall motion abnormalities, and circumferential pericardial effusion without significant respiratory changes in the mitral and tricuspid valves (Figure ). Lung CT scan showed bilateral GGO suggestive of viral pneumonia (Figure ) as well as the patient had a positive nasal and oropharyngeal PCR test for COVID-19. The patient received broad-spectrum antibiotics (meropenem [500 mg q8 h for 5 days] and doxycycline [200 mg/day]), corticosteroid (methylprednisolone 1 mg/kg/day), and remdesivir for COVID-19. However, the pericardial effusion was resolved by the third day after admission. Oxygen saturation increased to 95% after 5 days (without supplemental oxygen) and he was discharged in a satisfying condition. Follow-up of the patient for 3 months showed an LVEF of 45%, mild pericardial effusion, and normal right ventricular size and function.
A 14-year-old girl with a history of glucose-6-phosphate dehydrogenase (G6PD) deficiency was admitted with fever, cough, and dyspnea that had occurred since a week before admission. Moreover, she experienced loss of consciousness that had arisen about an hour before admission. Vital signs were as follows: body temperature = 38.2°C, systolic blood pressure = 60/50 mmHg, heart rate = 145/min, and O2 saturation = 60% without oxygenation. Also, the GCS score was 12. The ECG showed sinus tachycardia and low-voltage limb leads. So, she was intubated immediately, and vasopressors were administered. The chest CT scan showed bilateral diffuse GGO and consolidations (Figure ) as well as she had a positive nasal and oropharyngeal PCR test for COVID-19. Furthermore, the patient was anemic (hemoglobin = 6 g/dl). Echocardiography demonstrated an LVEF of 15%, no pleural effusion, normal inferior vena cava, pulmonary arterial pressure of 30 mmHg, and normal LV and RV size. The patient received broad-spectrum antibiotics (meropenem [500 mg] and doxycycline [200 mg/day]), high-dose corticosteroid (methylprednisolone 1 g/day), and remdesivir for COVID-19. However, the patient died in virtue of acute respiratory distress syndrome (ARDS).