CC BY-NC-ND 4.0 · Asian Journal of Oncology 2022; 08(03): 147-149
DOI: 10.1055/s-0042-1750018
Case Report

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

1   Department of Radiation Oncology, Hassan Institute of Medical Sciences, Hassan, Karnataka, India
B. Ravikiran
2   Department of Oncology, Hassan Institute of Medical Sciences, Hassan, Karnataka, India
N.P. Jayashree
3   Department of Radiation Oncology, Hassan Institute of Medical Sciences, Hassan, Karnataka, India
M. Anup
4   Department of Interventional Cardiology, Janapriya Hospital, Hassan, Karnataka, India
› Author Affiliations


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.

Publication History

Article published online:
14 July 2022

© 2022. Spring Hope Cancer Foundation & Young Oncologist Group of Asia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

  • References

  • 1 Moores DW, Allen KB, Faber LP. et al. Subxiphoid pericardial drainage for pericardial tamponade. J Thorac Cardiovasc Surg 1995; 109 (03) 546-551 , discussion 551–552
  • 2 Dosios T, Theakos N, Angouras D, Asimacopoulos P. Risk factors affecting the survival of patients with pericardial effusion submitted to subxiphoid pericardiostomy. Chest 2003; 124 (01) 242-246
  • 3 Koo JS, Jung W, Jeong J. Metastatic breast cancer shows different immunohistochemical phenotype according to metastatic site. Tumori 2010; 96 (03) 424-432
  • 4 Posner MR, Cohen GI, Skarin AT. Pericardial disease in patients with cancer. The differentiation of malignant from idiopathic and radiation-induced pericarditis. Am J Med 1981; 71 (03) 407-413
  • 5 Heudobler D, Lüke F, Vogelhuber M. et al. Anakoinosis: correcting aberrant homeostasis of cancer tissue-going beyond apoptosis induction. Front Oncol 2019; 9: 1408 DOI: 10.3389/fonc.2019.01408.
  • 6 Hart C, Vogelhuber M, Wolff D. et al. Anakoinosis: communicative reprogramming of tumor systems - for rescuing from chemorefractory neoplasia. Cancer Microenviron 2015; 8 (02) 75-92