Document Type
Conference Proceeding
Publication Date
5-3-2024
Abstract
Introduction Acute pericarditis is caused by inflammation of the pericardial sac. Amongst the vast number of potential causes, viruses tend to trigger pericarditis most frequently. Some of the more common viral causes are coxsackie A/B, echovirus, adenovirus, CMV, HSV, and HIV.1-3 Pericarditis often presents with signs and symptoms such as a friction rub, pain relieved with sitting up and leaning forward. ST segment elevations and PR segment depressions are seen on EKG. Laboratory tests showed increased inflammatory markers and WBC count. Pericardial effusion is a common complication and can be visualized on echocardiogram. In some cases, the pericardial effusion can be hemorrhagic in nature, which is extremely rare in the setting of viral pericarditis. The most common causes of hemorrhagic effusion are myocardial infarction, trauma, aortic dissection, or CABG surgery. Pericardial effusion can sometimes result in serious complications such as cardiac tamponade.4-6 NSAIDs, colchicine, and in some cases, prednisone can be used to treat pericarditis. In cases of significant pericardial effusion, pericardiocentesis may be required.6-8 We present an interesting case of pericarditis caused by the Coxsackie B virus causing significant hemorrhagic pericardial effusion requiring pericardiocentesis in a young patient. Presentation A 37-year-old female with no past medical history presented with substernal chest pain radiating to the left arm and shoulder that improved with leaning forward and dyspnea for two weeks. She also had a 2-week history of a cough, dysphagia, fever, and chills that started 2 days prior to the presentation. Vitals were remarkable for tachycardia in the 110s and tachypnea when breathing room air. Physical exam was unremarkable with no signs of edema, jugular venous distension, or muffled heart sounds. EKG showed widespread ST elevations and this is consistent with a diagnosis of pericarditis. Echocardiogram suggested acute pericarditis with a large pericardial effusion. 350mL of fluid was removed by pericardiocentesis. Cell count showed 201,000 RBCs/mcL and 9,350 nucleated cells/mcL. Cytology negative for malignancy. Cultures were negative for bacteria and fungi. Serum serology showed elevated inflammatory markers, CRP 140 mg/L and ESR 112 mm/hr. Increased Coxsackie B antibody titers, 1:160 for type 2 and 1:320 for type 3. Troponin levels were normal. She improved with pericardiocentesis and had minimal recurrence after drain removal. She was started on NSAIDs and colchicine. Discussion This is a unique case showing that while small exudative pericardial effusions may occur with viral pericarditis, viral infections can also cause a significant hemorrhagic pericardial effusion. Most Coxsackie virus infections are benign; however, there are a few documented case reports of hemorrhagic pericardial effusion from Coxsackie B causing tamponade and death.1,9 This case highlights the importance of considering viral infections as a potential cause of hemorrhagic tamponade, especially in young males during autumn and winter months, as those patients are at the highest risk.10
Recommended Citation
Shoukri N, Alakhras H, Strubchevska K, Timmis S. Rare case of hemorrhagic pericardial effusion due to Coxsackie B pericarditis. Presented at: American College of Physicians Michigan Chapter and Society of Hospital Medicine Michigan Chapter 2024 Resident and Medical Student Day; 2024 May 3; Troy, MI
Comments
American College of Physicians Michigan Chapter and Society of Hospital Medicine Michigan Chapter 2024 Resident and Medical Student Day, May 3, 2024, Troy, MI