In that study increased TNF-alpha level and high TNF-alpha/ Low TGF- beta1 pattern was found in viral pericardial effusion rather than neoplastic and autoreactive ones.21 TNF-alpha is an important cytokine in nearly all acute inflammatory reaction is increased significantly in patients with COVID-19 but couldn’t distinguish moderate versus severe disease presentation but is correlated with end organ damage.22 Whether different pattern of cytokines expression is the cause of distinct clinical presentation, such as existenced of pericardial effusion should be confirmed in in future studies. Here, TNF is linked to pericardial effusion.