A Case of Malignant Pericardial Effusion, Complicated by COVID-19: Challenges and Successful Management in Rural India

Background Malignant pericardial effusion (MPE) is a rare presentation in cancer, associated with high morbidity and mortality. Pericardial effusion may cause cardiac tamponade and sudden death without timely intervention. Management of MPE in rural setting during coronavirus disease 2019 (COVID-19) pandemic would require a multidisciplinary team in a center with expertise and could be a challenge in rural India with limited resources. Methods Here we present a case of MPE of unknown origin in a 40-year-old woman, complicated by COVID-19 infection, which was successfully managed in a rural health setting in southern India. Results She was subjected to prompt pericardiocentesis to relieve symptoms and dose-dense palliative chemotherapy followed by metronomic chemotherapy and pro-anakoinosis therapy during COVID-19 home isolation. She currently has no evidence of disease and is tolerating treatment well. Conclusion Complex oncological emergencies like MPE of unknown origin can be managed in rural setting in India, with a slight modification of existing facility resulting in successful outcomes. This case of MPE in a 40-year-old lady is a glaring example of how the same can be achieved. Principle of pro-anakoinosis can be of value not only during pandemics and lockdowns but also otherwise, the feasibility of which has to be elucidated in larger studies.