Detection of SARS-CoV-2 and HHV-8 from a large pericardial effusion in an HIV-positive patient with COVID-19 and clinically diagnosed Kaposi sarcoma: a case report
Abstract Background Pericardial effusion is a late manifestation of HIV more commonly observed in individuals with depressed CD4 counts. Although Mycobacterium tuberculosis remains to be one of the most frequently identified pathogens in the pericardial fluid among people living with HIV, less commo...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-09-01
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| Series: | Tropical Medicine and Health |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s41182-022-00464-x |
| _version_ | 1828175421573693440 |
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| author | Ryan R. Yanes Greco Mark B. Malijan Lyka Kymm Escora-Garcia Stephanie Angel M. Ricafrente Mary Jane Salazar Shuichi Suzuki Chris Smith Koya Ariyoshi Rontgene M. Solante Edna M. Edrada Kensuke Takahashi |
| author_facet | Ryan R. Yanes Greco Mark B. Malijan Lyka Kymm Escora-Garcia Stephanie Angel M. Ricafrente Mary Jane Salazar Shuichi Suzuki Chris Smith Koya Ariyoshi Rontgene M. Solante Edna M. Edrada Kensuke Takahashi |
| author_sort | Ryan R. Yanes |
| collection | DOAJ |
| description | Abstract Background Pericardial effusion is a late manifestation of HIV more commonly observed in individuals with depressed CD4 counts. Although Mycobacterium tuberculosis remains to be one of the most frequently identified pathogens in the pericardial fluid among people living with HIV, less commonly described etiologies include SARS-CoV-2 that causes coronavirus disease and human herpesvirus-8 which is associated with Kaposi sarcoma. Isolation of more than one pathogen in normally sterile sites remains challenging and rare. We report the first documentation of both SARS-CoV-2 and HHV-8 in the pericardial fluid. Case presentation We present the case of a young man in his 20s with a recent history of clinically diagnosed pulmonary tuberculosis who was admitted for progressive dyspnea and cough. He had multiple violaceous cutaneous lesions on the face, neck, and trunk and diffused lymphadenopathies. He tested positive for SARS-CoV-2 on admission. The patient was clinically diagnosed with pneumonia, Kaposi sarcoma, and HIV/AIDS. Empiric broad spectrum antimicrobial regimen was subsequently initiated. HIV with low CD4 count was confirmed during hospitalization. Echocardiography revealed a large pericardial effusion, in impending cardiac tamponade. Frond-like fibrin strands, extending to the parietal pericardium, were also observed. Pericardiostomy yielded hemorrhagic, exudative effusion with lymphocytic predominance. SARS-CoV-2 and HHV-8 were detected in the pericardial fluid, and bacterial, fungal, and tuberculous studies were negative. The patient had clinical improvement after pericardial drainage. However, despite our best clinical care, he developed a nosocomial infection leading to clinical deterioration and death. Conclusion Detection of SARS-CoV-2 and HHV-8 in the pericardial fluid is rare, and interpretation of their significance in clinical care is challenging. However, coronavirus disease and Kaposi sarcoma must be considered and adequately addressed in immunocompromised adults presenting with large pericardial effusion. |
| first_indexed | 2024-04-12T04:27:55Z |
| format | Article |
| id | doaj.art-9aa9aaafab904850ae9b9f060b38bb02 |
| institution | Directory Open Access Journal |
| issn | 1349-4147 |
| language | English |
| last_indexed | 2024-04-12T04:27:55Z |
| publishDate | 2022-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Tropical Medicine and Health |
| spelling | doaj.art-9aa9aaafab904850ae9b9f060b38bb022022-12-22T03:48:02ZengBMCTropical Medicine and Health1349-41472022-09-015011810.1186/s41182-022-00464-xDetection of SARS-CoV-2 and HHV-8 from a large pericardial effusion in an HIV-positive patient with COVID-19 and clinically diagnosed Kaposi sarcoma: a case reportRyan R. Yanes0Greco Mark B. Malijan1Lyka Kymm Escora-Garcia2Stephanie Angel M. Ricafrente3Mary Jane Salazar4Shuichi Suzuki5Chris Smith6Koya Ariyoshi7Rontgene M. Solante8Edna M. Edrada9Kensuke Takahashi10San Lazaro Hospital – Adult Infectious Diseases and Tropical Medicine DepartmentSan Lazaro Hospital – Nagasaki University Collaborative Research OfficeSan Lazaro Hospital – Adult Infectious Diseases and Tropical Medicine DepartmentSan Lazaro Hospital – Adult Infectious Diseases and Tropical Medicine DepartmentSan Lazaro Hospital – Nagasaki University Collaborative Research OfficeSan Lazaro Hospital – Nagasaki University Collaborative Research OfficeNagasaki University – School Tropical Medicine and Global HealthNagasaki University – School Tropical Medicine and Global HealthSan Lazaro Hospital – Adult Infectious Diseases and Tropical Medicine DepartmentSan Lazaro Hospital – Adult Infectious Diseases and Tropical Medicine DepartmentNagasaki University – School Tropical Medicine and Global HealthAbstract Background Pericardial effusion is a late manifestation of HIV more commonly observed in individuals with depressed CD4 counts. Although Mycobacterium tuberculosis remains to be one of the most frequently identified pathogens in the pericardial fluid among people living with HIV, less commonly described etiologies include SARS-CoV-2 that causes coronavirus disease and human herpesvirus-8 which is associated with Kaposi sarcoma. Isolation of more than one pathogen in normally sterile sites remains challenging and rare. We report the first documentation of both SARS-CoV-2 and HHV-8 in the pericardial fluid. Case presentation We present the case of a young man in his 20s with a recent history of clinically diagnosed pulmonary tuberculosis who was admitted for progressive dyspnea and cough. He had multiple violaceous cutaneous lesions on the face, neck, and trunk and diffused lymphadenopathies. He tested positive for SARS-CoV-2 on admission. The patient was clinically diagnosed with pneumonia, Kaposi sarcoma, and HIV/AIDS. Empiric broad spectrum antimicrobial regimen was subsequently initiated. HIV with low CD4 count was confirmed during hospitalization. Echocardiography revealed a large pericardial effusion, in impending cardiac tamponade. Frond-like fibrin strands, extending to the parietal pericardium, were also observed. Pericardiostomy yielded hemorrhagic, exudative effusion with lymphocytic predominance. SARS-CoV-2 and HHV-8 were detected in the pericardial fluid, and bacterial, fungal, and tuberculous studies were negative. The patient had clinical improvement after pericardial drainage. However, despite our best clinical care, he developed a nosocomial infection leading to clinical deterioration and death. Conclusion Detection of SARS-CoV-2 and HHV-8 in the pericardial fluid is rare, and interpretation of their significance in clinical care is challenging. However, coronavirus disease and Kaposi sarcoma must be considered and adequately addressed in immunocompromised adults presenting with large pericardial effusion.https://doi.org/10.1186/s41182-022-00464-xHIVKaposi sarcomaHHV-8COVID-19SARS-CoV-2Tuberculosis |
| spellingShingle | Ryan R. Yanes Greco Mark B. Malijan Lyka Kymm Escora-Garcia Stephanie Angel M. Ricafrente Mary Jane Salazar Shuichi Suzuki Chris Smith Koya Ariyoshi Rontgene M. Solante Edna M. Edrada Kensuke Takahashi Detection of SARS-CoV-2 and HHV-8 from a large pericardial effusion in an HIV-positive patient with COVID-19 and clinically diagnosed Kaposi sarcoma: a case report Tropical Medicine and Health HIV Kaposi sarcoma HHV-8 COVID-19 SARS-CoV-2 Tuberculosis |
| title | Detection of SARS-CoV-2 and HHV-8 from a large pericardial effusion in an HIV-positive patient with COVID-19 and clinically diagnosed Kaposi sarcoma: a case report |
| title_full | Detection of SARS-CoV-2 and HHV-8 from a large pericardial effusion in an HIV-positive patient with COVID-19 and clinically diagnosed Kaposi sarcoma: a case report |
| title_fullStr | Detection of SARS-CoV-2 and HHV-8 from a large pericardial effusion in an HIV-positive patient with COVID-19 and clinically diagnosed Kaposi sarcoma: a case report |
| title_full_unstemmed | Detection of SARS-CoV-2 and HHV-8 from a large pericardial effusion in an HIV-positive patient with COVID-19 and clinically diagnosed Kaposi sarcoma: a case report |
| title_short | Detection of SARS-CoV-2 and HHV-8 from a large pericardial effusion in an HIV-positive patient with COVID-19 and clinically diagnosed Kaposi sarcoma: a case report |
| title_sort | detection of sars cov 2 and hhv 8 from a large pericardial effusion in an hiv positive patient with covid 19 and clinically diagnosed kaposi sarcoma a case report |
| topic | HIV Kaposi sarcoma HHV-8 COVID-19 SARS-CoV-2 Tuberculosis |
| url | https://doi.org/10.1186/s41182-022-00464-x |
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