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Fatal pericarditis due to Mycobacterium avium-intracellulare in acquired immunodeficiency syndrome.

A 27-year-old white male homosexual with AIDS presented 19 months after the initial diagnosis with persistent fever, marked dyspnea at rest, and severe substernal pain in the chest. A pericardial friction rub was auscultated, and an effusion was demonstrated echocardiographically. Pericardiocentesis yielded 220 ml of serosanguinous fluid. Special stains of the fluid for microorganisms were negative. A mycobacterial infection was suspected, and therapy with multiple antimycobacterial agents was initiated. Cultures of the fluid eventually yielded MAI. Despite therapy, cardiac function declined, and the patient died two months after presentation. Autopsy confirmed the diagnosis of chronic pericarditis due to MAI. Pericarditis due to MAI should be included in the differential diagnosis of cardiac dysfunction in patients with AIDS.

Acquired Immunodeficiency Syndrome↗

Recurrent pericarditis and dermatitis herpetiformis. Evidence for immune complex deposition in the pericardium.

Recurrent pericarditis can be associated with many chronic illnesses. Dermatitis herpetiformis is a chronic papulovesicular eruption which is characterized by granular IgA deposits in the dermal papillary tips and associated with a gluten-sensitive enteropathy. We describe the first case of recurrent pericarditis in association with dermatitis herpetiformis. This supposition is supported by exclusion of other possible etiologies and pericardial biopsy which revealed the deposition of IgG, IgA and complement.

Complement System Proteins↗

Esophagoatrial fistula with previous pericarditis complicating esophageal ulceration. Report of two cases and a review of the literature.

Sixteen cases of nontraumatic left atrial-esophageal fistulas have been reported previously. These fistulas usually result from chronic peptic esophagitis or cancer. The diagnosis is suggested by the triad of chronic dysphagia, hematemesis, and acute neurologic signs. There may be cardiac manifestations such as pericarditis, atrial fibrillation, or shock. An unusual feature of these fistulas is systemic embolization of food, air, or septic necrotic debris which may result in sudden central nervous system symptoms. All reported cases resulted in death due to hemorrhage, although there was often a variable time interval between the onset of hematemesis and the patient's death. The authors report two additional cases in which an episode of pericarditis preceded fistula development. Based on these 18 cases, the spectrum of esophagoatrial fistulas is reviewed, as well as the signs which may herald fistula development.

Aged↗

Presystolic pulmonary valve opening in constrictive pericarditis.

Right heart pressure tracings were studied in 5 cases with constrictive pericarditis. The pressure of the A-wave in the right atrium of these cases was higher than the pulmonary arterial diastolic pressure. In addition, a presystolic wave appeared in the pulmonary arterial and the right ventricular pressure tracings, in coincidence with atrial systole. The pressure of this presystolic wave was similar to that of the right atrial A-wave. This suggests that the pulmonary valve opens following atrial systole, and then the blood flows into the pulmonary artery in the presystolic phase in patients with constrictive pericarditis. In 2 cases, pulmonary valve echograms were recorded. The a-dip in these 2 cases was as deep as 8.4 mm and 9.6 mm (1.8-4.1 mm with a mean of 2.80 mm for normal men), and its duration was prolonged to 0.17 sec and 0.18 sec (0.10-0.13 sec with a mean of 0.115 sec for normal men). In conclusion, such a deep and prolonged a-dip on pulmonary valve echogram is presumably a sign of presystolic pulmonary valve opening.

Adult↗

Acute myocardial infarction with a hemodynamic pattern resembling constrictive pericarditis.

A 49-year-old woman experienced acute myocardial infarction with a hemodynamic pattern resembling constrictive pericarditis. To clarify its mechanism, we performed right atrial pacing and volume challenge test during the chronic state. Although these two interventions elevated diastolic pressures of the both ventricles, the dip and plateau pattern was not reproduced. Factors other than ischemia may be important in producing a hemodynamic pattern resembling constrictive pericarditis in acute myocardial infarction.

Blood Pressure↗

Constrictive pericarditis associated with right atrial and major venous thrombosis.

Right atrial thrombi are very rare. Existence of right atrial thrombus with constrictive pericarditis is even rarer. Only few cases have been reported in the English literature. Here, we report an unusual case of constrictive pericarditis complicated with right atrial and major venous thrombi. The patient underwent a successful pericardiectomy procedure. He had no thrombi during the follow-up period.

Adult↗

Pericarditis and pleuritis caused by Corynebacterium pseudotuberculosis in a horse.

A 13-year-old Oldenburg mare was evaluated for lethargy and signs of mild colic. Pericardial tamponade caused by fibrinoeffusive pericarditis was diagnosed. Cytologic and biochemical evaluation of pericardial fluid was consistent with a septic effusion. Corynebacterium pseudotuberculosis, the cause of pigeon fever, was identified by bacteriologic culture of pericardial fluid. Drainage and lavage of the pericardial sac, local (intrapericardial) and systemic antimicrobial treatment, and subsequent corticosteroid treatment resulted in a successful outcome in this horse. To the authors' knowledge, this is the first report of pericarditis associated with C pseudotuberculosis in a horse.

Adrenal Cortex Hormones↗

Fatal Listeria meningitis, endocarditis and pericarditis in a patient with haemochromatosis.

A 65-year-old man with primary haemochromatosis was admitted because of fever and confusion. He was found to have bacteraemia and meningitis due to Listeria monocytogenes. Treatment with ampicillin plus tobramycin was instituted, and despite an initial improvement, the patient experienced an unfavourable course and died. At postmortem examination, tricuspid valve endocarditis and purulent pericarditis with tamponade were detected. Listeria monocytogenes grew in the culture of the pericardial fluid. Documentation of Listeria monocytogenes pericarditis is extremely rare, and data on the patient described and on seven published cases are reported.

Aged↗

Toxoplasma pericarditis mimicking systemic lupus erythematosus. Diagnostic and treatment difficulties in one patient.

A life-threatening T. gondii pericarditis developed in a patient with symptoms corresponding to systemic lupus erythematosus (SLE) with high concentrations of antinuclear antibodies and lymphadenopathy. The diagnosis would have been SLE-associated serositis, had not pericardial fluid been inoculated into mice, because pericarditis is frequently seen in SLE and false positive toxoplasma seroreactions may occur in ANA positive patients. High IgG T. gondii antibodies without increased IgM antibodies indicated reactivation rather than primary infection. Prolonged high-dose treatment with pyrimethamine-sulphadiazine was needed. Interestingly, the patient's SLE symptoms, including high ANA antibodies, declined to an unexpected remission after treatment for toxoplasmosis. This may not be mere coincidence, but may point to a causative role of toxoplasmosis in some cases of SLE.

Animals↗

Cardiac tamponade secondary to hemorrhagic pericarditis during continuous hemofiltration for renal failure. The role of the anticoagulant.

Cardiac tamponade secondary to hemorrhagic pericarditis during continuous hemofiltration (CHF) for renal failure is reported. Cardiac tamponade developed while heparin was being used as an anticoagulant and did not recur when nafamostat mesilate was substituted. The role of the anticoagulant in the etiology of hemorrhagic pericarditis in dialysis patients is discussed.

Cardiac Tamponade↗

Purulent pericarditis in children. Review and case report.

Acute purulent pericarditis is infrequent in children. Only around 200 cases have been reported in the western literature in the past 25 years (1-10). From the Scandinavian countries only two cases have been described (6, 7). Purulent pericarditis is usually a complication of upper respiratory tract infection. Mortality is very high in unrecognized or inadequately treated cases. Early diagnosis and appropriate treatment with adequate surgical drainage and antimicrobial therapy are vitally important for the outcome.

Child, Preschool↗

Constrictive pericarditis after surgical closure of atrial septal defect in a child.

Constrictive pericarditis following an open cardiac surgery for congenital heart disease is very rarely encountered in children. We report a case of constrictive pericarditis, diagnosed at 22 months after surgical closure of an atrial septal defect, in a 14-year-old boy who presented postpericardiotomy syndrome. Cardiac catheterization revealed uniformity of elevated diastolic pressures in all chambers, prominent x and y descents in the right atrial pressure tracing, and typical "dip and plateau" contour of ventricular end-diastolic pressures. Pericardiectomy improved the hemodynamic status of the patient. He remains symptom-free during the follow-up period of 12 months.

Child↗

Purulent pericarditis caused by group G streptococcus as an initial presentation of colon cancer.

Bacterial pericarditis has been recognized as a rare disease since the development of antibiotics. Usually, the disease is associated with underlying conditions or a seeding of infection elsewhere to the pericardium. Here we describe a case of group G streptococcal pericarditis as an initial presentation of colon cancer. A 52-yr-old man was admitted because of dyspnea. An electrocardiogram showed a diffuse ST-segment elevation and a two-dimensional echocardiogram showed a large amount of pericardial effusion. A pericardiocentesis was done and purulent fluid was drained. Group G streptococci was cultured in pericardial fluid. The patient was treated with antibiotics and pericardiostomy with saline irrigation. A colonoscopy revealed a small mass with moderately differentiated adenocarcinoma in rectosigmoid colon. He underwent a mucosectomy and was recovered without any complication.

Adenocarcinoma↗

A case of Behçet's disease with pericarditis, thrombotic thrombocytopenic purpura, deep vein thrombosis and coronary artery pseudo aneurysm.

Behçet's disease with concomitant thrombotic thrombocytopenic purpura (TTP), coronary artery stenosis and coronary artery pseudo aneurysm is rare. Here we report a case of Behçet's disease with several cardiovascular complications, namely: pericarditis, deep vein thrombosis (DVT), TTP, coronary artery stenosis, and a coronary artery pseudo aneurysm. A 37-year-old female presented with sudden dyspnea and syncope at our emergency room and underwent pericardiectomy and pericardial window formation for the diagnosis of cardiac tamponade with acute hemorrhagic pericarditis. Thereafter, TTP and DVT complicated her illness. After confirmation of Behçet's disease on the basis of a history of recurrent oral and genital ulcers and erythema nodosum, remission was achieved after treatment with methylprednisolone pulse therapy, colchicine, catheter directed thrombolysis and thrombectomy. However, whilst maintaining anticoagulation therapy, a newly developed pericardial aneurysmal dilatation was noted on follow-up radiologic evaluation. Further evaluation revealed right coronary artery stenosis and a left coronary artery pseudo aneurysm; these additional problems were treated with the nonsurgical insertion of an endovascular graft stent. At the time of writing three months later after stent insertion, the aneurysm has continued to regress and no additional complications have intervened with combined immunosuppressive therapy.

Adult↗

Doppler echocardiographic assessment of constrictive pericarditis, cardiac amyloidosis, and cardiac tamponade.

Doppler echocardiography is useful in assessing diastolic dysfunction. Pulsed-wave Doppler echocardiographic interrogation of the atrioventricular valves and the central veins has been used in conjunction with respiratory monitoring to characterize abnormal diastolic function of the heart in diseases such as constrictive pericarditis, restrictive cardiomyopathy, and cardiac tamponade. Constrictive pericarditis has distinct Doppler flows with marked respiratory variation because the pericardial shell separates the intracardiac pressures from intrathoracic pressure. This is not the case with restrictive cardiomyopathy, as in cardiac amyloidosis. Cardiac amyloidosis shows a spectrum of the Doppler flows which evolve as the disease progresses from abnormal relaxation in the early phase to pseudo-normal in the intermediate phase and to restrictive in the advanced phase. Doppler echocardiography can be used to assess the hemodynamic significance of pericardial effusion and to detect cardiac tamponade.

Amyloidosis↗

Mycoplasma-associated pericarditis.

Mycoplasma pneumoniae-associated pericarditis may result in pronounced morbidity unless appropriate therapy is administered. In this report, we describe a patient who had recurrent episodes of chest pain, intermittent constitutional symptoms, and, eventually, cardiac tamponade due to pericarditis despite treatment with nonsteroidal anti-inflammatory drugs. Immunofluorescence antibody titers were consistent with recent M. pneumoniae infection, and antibiotic therapy resulted in rapid and complete resolution of the patient's symptoms. This treatable entity may be underrecognized and can now be diagnosed with sensitive serologic testing.

Diagnosis, Differential↗

Hodgkin's disease presenting as pericarditis.

Two patients presented with initial symptoms of pericarditis. Palpable lymph nodes developed a few weeks later and a diagnosis of Hodgkin's disease was made. Although rare, this mode of presentation of Hodgkin's disease has been reported previously, and it should be considered in the differential diagnosis of any patient with pericarditis with severe general symptoms or a prolonged course.

Adult↗

Pericarditis during infection with Mycoplasma pneumoniae.

A 37-year-old woman was found to have pericarditis during the course of a Mycoplasma pneumoniae infection which also produced primary atypical pneumonia. Intrafamily spread of the infection was observed, with varying clinical manifestations. The case is described because there appears to be little information on mycoplasma pericarditis.

Adult↗