Dear Editor,

We would like to share our thoughts on the publication “A case of a very large haemorrhagic pericardial effusion in an adolescent patient with COVID-19 infection. ^{Reference Gokalp, Çilsal, Yukcu, Yolcu, Akkoc and Guzeltas1} ” Gokalp et al noted that “a large pericardial effusion may complicate COVID-19 in children and should be considered in acute decompensation. ^{Reference Gokalp, Çilsal, Yukcu, Yolcu, Akkoc and Guzeltas1} ” Cardiac complications are possible in COVID-19. Pericardial effusion has been observed in patients with COVID-19, but it is typically not a hemorrhagic effusion. ^{Reference Sauer, Dagrenat, Couppie, Jochum and Leddet2} Further in pericardial effusion, the hemorrhagic effusion in the present case might or might not be associated with COVID-19. Bleeding is a possible problem in COVID–19. ^{Reference Joob and Wiwanitkit3} A hemopericardium could occur if there is severe coagulopathy, but the patient would be expected to have other bleeding problems. Whether the patient has an underlying hemostatic disorder requires a complete laboratory work-up. Finally, the pericardial effusion might be a coincidence. In a developing Asian country, there are many underlying conditions such as tuberculosis that can cause pericardial effusion and concurrent COVID–19 and tuberculosis infections have been reported in the literature. ^{Reference Yasri and Wiwanitkit4}