COVID-19 Associated Pneumonia and Pleural Effusion Masquerading as Heart Failure in Rheumatic Heart Disease

The ongoing outbreak of coronavirus disease 2019 (COVID-19) that began in Wuhan, China, became an international emergency when thousands of people were infected around the world. COVID-19 emerged in Pakistan in April 2020, precipitating a nationwide lockdown. While some countries are now recovering from the pandemic, its peak is not estimated to occur in Pakistan until August 2020. We present a case of rheumatic heart disease with fever, myalgia and an unusual radiological finding of the virus. LEARNING POINTS: Unusual radiological findings are being seen in COVID-19 patients. Pleural effusion in a mildly symptomatic patient is a rare presentation of the disease. Early aggressive treatment can produce dramatic improvement in COVID-19 pneumonia.