Tuberculous Pericarditis in a Patient with COVID-19

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Abstract
A 23-year-old male presenting to the emergency department with cough and fever for 2 days tested positive for COVID-19 by rapid antigen test (SD Biosensor, Roche Diagnostics India), per our hospital policy. He was admitted to our dedicated COVID-19 Centre, where the diagnosis was confirmed by reverse transcription-PCR. A commercial real-time reverse transcription-PCR kit (BGI Genomics Co. Ltd.), which has Emergency Use Authorization from the US Food and Drug Administration and approval from the Indian Council of Medical Research) was used. His past history was remarkable for the diagnosis of acute myeloblastic leukemia (AML) 2 months back, for which he had received induction chemotherapy and was in remission. Past history of tubercular lymphadenitis was also present; however, treatment records were not available. After an initial improvement, he developed sudden-onset chest pain, radiating to the neck, on day 9. An acute coronary syndrome was ruled out by electrocardiogram and serial Troponin I. A two-dimensional transthoracic echocardiography revealed massive circumferential pericardial effusion with a maximum thickness of 9 mm anterior to the right ventricle. A complete blood count showed pancytopenia. No evidence of pneumonia was visible on the chest radiograph. Blood and urine cultures collected on the day had no growth. Pericardiocentesis was performed to drain the fluid; this was transported to the microbiology laboratory for bacterial culture and sensitivity. Considering the patient's history and current status, we considered 4 possible differential diagnoses: community-acquired fastidious bacteria, leukemic pericarditis after a recurrence of AML, tubercular pericarditis, and atypical presentation of COVID-19.