(173) A Case of Intractable Pleural and Pericardial Effusions

Introduction: Post-COVID-19 hemorrhagic polyserositis is an uncommon and challenging diagnosis of exclusion. Pathophysiology is poorly understood which unfortunately makes it difficult to manage. Due to this relatively new disease process, there are no established management guidelines, therefore this case is meant to increase the awareness and strategies that were taken to manage this unique case.

Description: This is a case of a 44-year-old who was initially admitted in mid-2021 for COVID-19 infection and later discharged after symptomatic improvement. However, from 2021-2022, the patient would require multiple hospital admissions for the management of recurrent pleural and pericardial effusions.

On the patient’s penultimate admission, she underwent multiple thoracentesis and eventually chest tube placement. Analysis of pleural effusion demonstrated a hemorrhagic exudative pleural effusion pattern with culture and cytology negative. After a decrease in the size of the pleural effusion, CT thorax demonstrated left supraclavicular adenopathy and possible bony metastasis of the thoracic spine. Additionally, CT abdomen showed questionable masses around the liver. The patient underwent subsequent image-guided biopsies that were both negative for malignancy. A bone scan did not demonstrate any focal uptake. The patient also underwent significant immunological testing with IgG subclasses and rheumatological makers which were mainly negative.

As other diagnoses were excluded, post-COVID-19 hemorrhagic polyserositis was considered. After shared decision-making with the patient, a plan was created to start colchicine and a high-dose non-steroidal anti-inflammatory drug (NSAID) taper. Shortly then after, the patient’s symptoms improved and was discharged without significant relapse of the pleural effusions and hospital admissions.

Discussion: The COVID-19 pandemic is/was undoubtedly a challenging experience and consequently led to the rise of new complications with post-COVID-19 hemorrhagic polyserositis being one of them; the literature remains sparse regarding this relationship. However, it is important to consider and rule out polyserositis as a rare complication of COVID-19 and continue discovering novel therapies to best help our patients.