Systemic Lupus Erythematosus Complicated by Pericarditis: A Case Report from the Guindo Clinic in Bamako, Mali

Juvenile systemic lupus erythematosus is a rare entity, affecting children under 16 years of age. Girls are more often affected than boys and the female predominance increases significantly with age. The initial manifestations are highly variable with an insidious and progressive onset. Non-specific symptoms include fever, anorexia, weight loss and asthenia. Pericarditis is the most common cardiac manifestation in systemic lupus erythematosus (SLE), occurring in 10% to 40% of cases. The biological elements of the diagnosis and follow-up of pediatric SLE are identical to those of adults and are based on regular measurement of complement, native anti-DNA antibodies, and inflammatory findings. Treatment is essentially based on corticosteroid therapy.

One Case of Acute Fluid Pericarditis and Hyperthyroidism at Teaching Hospital of Bouake (Ivory Coast): Cause-Effect Relationship or Accidental Association?

Cardiovascular complications during hyperthyroidism are dominated by arrhythmias, heart failure and coronary heart disease. Pericardial effusion which is a common complication of hypothyroidism is extremely rare in hyperthyroidism. We report the case of a 45-year-old woman admitted for management of pleuro-pericarditis associated with atrial fibrillation in the context of cardiothyreosis. The treatment consisted of a pericardial puncture associated with synthetic anti-thyroid drugs and anti-tuberculosis drugs with positive clinical and echocardiographic outcomes.

Chronic Effusive Pericarditis and Chronic Constrictive Pericarditis

Chronic Pericarditis is infl ammation that begins gradually,is long lasting and results in fl uid accumulation in the pericardial space or thickening of the pericardium.The etiology is unknown but may be cancer,TB or hypothyroidism.Arrhythmias are common and seen in almost half the patients.The commonest arrhythmia is atrial fi brillation.Symptoms and signs are related to increased right atrial pressure and physical fi ndings include elevated JVP and pericardial knock.Non surgical therapy consists mainly of no salt.Surgery cures about 85%of patients,however 5–15%of patients will die.Chronic effusive pericarditis occurs when there is persistent restriction of the visceral pericardium after pericardiocentesis.

Salmonella typhimurium myopericarditis: A case report and review of literature

BACKGROUND Non-typhoidal salmonella(NTS)is a rare,but well-established cause of myopericarditis.Presenting symptoms may be varied,however often revolve around the dual presentation of both myopericarditis and infectious diarrhoea.Given the rarity of NTS related myopericarditis,we conducted a systematic review of the literature,identifying 41 previously reported cases.CASE SUMMARY We present the case of an otherwise healthy 39-year old male,presenting with chest pain in the setting of documented Salmonella typhimurium infection.After further investigation with echocardiogram and laboratory blood tests,a diagnosis of NTS associated myopericarditis was made,and the patient received antibiotic treatment with an excellent clinical outcome.Overall,myopericarditis is rare in NTS.Although treatment for myopericarditis has not been well established,there are guidelines for the treatment of NTS infection.In our review,we found that the majority of NTS cases has been pericarditis(27/42,64.3%),with an average age of 48.3 years,and 71.4%being male.The average mortality across all cases was 31%.CONCLUSION Myopericarditis is a rare,but potentially serious complication of NTS infection,associated with an increased morbidity and mortality.

Pericarditis following COVID-19 vaccination:Two case reports

BACKGROUND Coronavirus disease 2019(COVID-19)is a highly contagious viral illness which conventionally manifests with primarily respiratory symptoms and less commonly with cardiac involvement in various forms,such as pericarditis.Myocarditis and pericarditis have been reported in a variety of live and attenuated vaccines,such as smallpox and influenza.As of October 2021,no cases of pericarditis associated with COVID-19 vaccination have been published.We present two healthy male patients who present post COVID-19 vaccination with pericarditis diagnoses.CASE SUMMARY A 21-year-old male with no significant past medical history presented with myalgia,chills,mild headache,and chest pain for two days.Patient received the Moderna COVID-19 vaccine the day prior to symptom onset.On presentation,electrocardiogram(ECG)revealed sinus rhythm with ST elevation,and troponin was elevated.Emergent cardiac catheterization was not significant for abnormalities.The primary diagnosis was acute pericarditis,and the patient was discharged on colchicine and indomethacin.Additionally,a 35-year-old male with no pertinent past medical history presented with fever,chills,weakness,nausea,vomiting,diarrhea,and retrosternal chest pain for three days.He received the Moderna COVID-19 vaccine four days prior to symptom onset.On presentation,troponin was elevated,and ECG revealed mild ST elevation.Left ventricular dysfunction with ejection fraction of 41%was reported on transthoracic echocardiogram.Patient was started on ibuprofen and colchicine for diagnosis of myopericarditis.CONCLUSION These case reports highlight a potential unintended consequence,pericarditis,associated with COVID-19 vaccination that may not warrant invasive cardiac intervention.

Established and novel pathophysiological mechanisms of pericardial injury and constrictive pericarditis

This review article aims to:(1) discern from the literature the immune and inflammatory processes occurring in the pericardium following injury; and(2) to delve into the molecular mechanisms which may play a role in the progression to constrictive pericarditis. Pericarditis arises as a result of a wide spectrum of pathologies of both infectious and non-infectious aetiology, which lead to various degrees of fibrogenesis. Current understanding of the sequence of molecular events leading to pathological manifestations of constrictive pericarditis is poor. The identification of key mechanisms and pathways common to most fibrotic events in the pericardium can aid in the design and development of novel interventions for the prevention and management of constriction. We have identified through this review various cellular events and signalling cascades which are likely to contribute to the pathological fibrotic phenotype. An initial classical pattern of inflammation arises as a result of insult to the pericardium and can exacerbate into an exaggerated or prolonged inflammatory state. Whilst the implication of major drivers of inflammation and fibrosis such as tumour necrosis factor and transforming growth factor β were foreseeable, the identification of pericardial deregulation of other mediators(basic fibroblast growth factor, galectin-3 and the tetrapeptide Ac-SDKP) provides important avenues for further research.

Acute and recurring pericarditis: More colchicine,less corticosteroids

Acute and recurring pericarditis are frequently encountered clinical entities.Given that severe complications such as tamponade and constrictive pericarditis occur rarely,the majority of patients suffering from acute pericarditis will have a benign clinical course.However,pericarditis recurrence,with its painful symptoms,is frequent.In effect,recent studies have demonstrated a beneficial role of colchicine in preventing recurrence,while also suggesting an increase in recurrences with the use of corticosteroids,the traditional first-line agent.

Pericarditis and chronic inflammatory demyelinating polyneuropathy during therapy with pegylated interferon alfa-2a for chronic hepatitis C

We report a case of pericarditis and chronic inflam- matory demyelinating polyneuropathy with biological signs of a lupus-like syndrome due to pegylated interferon alfa-2a therapy during treatment for chronic hepatitis C.The patient developed moderate weakness in the lower limbs and dyspnea.He was hospitalized for congestive heart failure.An electrocardiogram showed gradual ST-segment elevation in leads V1 through V6 without coronary artery disease.A transthoracic cardiac ultrasonographic study revealed moderate pericardial effusion with normal left ventricular function.Anti-DNA antibody and anti-ds DNA IgM were positive.Neu ro logical examination revealed a symmetrical predomina ntly sensory polyneuropathy with impairment of light touch and pin prick in globe and stoking-like distribution.Treatment with prednisolone improved the pericarditis and motor nerve disturbance and the treatment with intravenous immunoglobulin improved the sensory nerve disturbance.

Severe pneumonia and acute myocardial infarction complicated with pericarditis after percutaneous coronary intervention:A case report

BACKGROUND Cases of severe pneumonia complicated with acute myocardial infarction(AMI)with good prognosis after percutaneous coronary intervention(PCI)are rare,especially those with postoperative pericarditis and intestinal obstruction.CASE SUMMARY A 53-year-old male patient was admitted to the emergency department of our hospital because of paroxysmal chest tightness for 4 d,aggravated with chest pain for 12 h.The symptoms,electrocardiography,biochemical parameters,echocardiography and chest computed tomography confirmed the diagnosis of severe pneumonia complicated with AMI.The patient was treated with antiplatelet aggregation,anticoagulation,lipid regulation,vasodilation,anti-infective agents and direct PCI.The patient was discharged after 3 wk of treatment.Follow-up showed that the patient was asymptomatic without recurrence.CONCLUSION For patients with severe pneumonia complicated with AMI,PCI and antibiotic therapy is a life-saving strategy.

Eggshell calcification of the heart in constrictive pericarditis

Constrictive pericarditis(CP) is an inflammatory disease of pericardium. Pericardial calcification in X-ray provides a clue for the diagnosis of CP. An extensive "eggshell" type of calcification is rarely seen in CP. We hereby report a case of CP with eggshell calcification of pericardium, encircling whole of the heart. A need for multimodality imaging and hemodynamic assessment followed by surgical pericardiectomy is discussed.

Tuberculous pericarditis-a silent and challenging disease:A case report

BACKGROUND Tuberculous pericarditis(TP)remains a challenge for endemic countries.In developing countries,one to two percent of patients with pulmonary tuberculosis develops TP.CASE SUMMARY A 49-year-old woman presented with dyspnea,chest pain and dry cough.On physical examination,veiled heart sounds were found.The electrocardiogram showed low-voltage complexes and the transthoracic echocardiography revealed a large and free-looking pericardial effusion.The patient was taken for an open pericardiotomy.The pericardial fluid revealed high levels of adenosine deaminase and Ziehl-Neelsen stain showed acid-fast bacilli.Polymerase chain reaction study for Mycobacterium tuberculosis in pericardial fluid was positive.The patient received tetra conjugate management with adequate clinical response after the first week of treatment and resolution of fever and chest pain.CONCLUSION In cases of TP,obtaining pericardial fluid and/or pericardial biopsy is the most efficient strategy to confirm the diagnosis.Early diagnosis of this entity will allow physicians to initiate timely treatment,avoid complications and improve the patient's clinical outcome,so we consider the description of this case pertinent and its review in the literature.

Severe mediastinitis and pericarditis after endobronchial ultrasoundguided transbronchial needle aspiration:A case report

BACKGROUND Endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)is a safe and minimally invasive diagnostic tool for mediastinal and hilum evaluation.However,infectious complications may occur after EBUS-TBNA.Among these,mediastinitis and pericarditis are rare.CASE SUMMARY A 67-year-old woman was referred to our hospital due to paratracheal lymph node enlargement on chest computed tomography(CT).EBUS-TBNA was performed on the lymph node lesions,and prophylactic oral antibiotics were administered.Seven days after EBUS-TBNA,the patient visited the emergency room with a high fever and chest pain.Laboratory test results revealed leukocytosis with a left shift and elevated C-reactive protein level(25.7 mg/dL).Chest CT revealed the formation of a mediastinal abscess in the right paratracheal lymph node and pericardial and bilateral pleural effusions.The patient received intravenous antibiotic treatment,cardiac drainage through pericardiocentesis,and surgical management.The patient recovered favorably and was discharged 31 d after the operation.CONCLUSION Mediastinitis and pericarditis after EBUS-TBNA are rare but should be considered even after the use of prophylactic antibiotics.

Constrictive pericarditis as a cause of refractory ascites after liver transplantation:A case report

BACKGROUND Refractory ascites is a rare complication following orthotopic liver transplantation(OLT).The broad spectrum of differential diagnosis often leads to delay in diagnosis.Therapy depends on recognition and treatment of the underlying cause.Constrictive pericarditis is a condition characterized by clinical signs of right-sided heart failure.In the advanced stages of the disease,hepatic congestion leads to formation of ascites.In patients after OLT,cardiac etiology of ascites is easily overlooked and it requires a high degree of clinical suspicion.CASE SUMMARY We report a case of a 55-year-old man who presented with a refractory ascites three months after liver transplantation for alcoholic cirrhosis.Prior to transplantation the patient had a minimal amount of ascites.The transplant procedure and the early postoperative course were uneventful.Standard posttransplant work up failed to reveal any typical cause of refractory post-transplant ascites.The function of the graft was good.Apart from atrial fibrillation,cardiac status was normal.Eighteen months post transplantation the patient developed dyspnea and severe fatigue with peripheral edema.Ascites was still prominent.The presenting signs of right-sided heart failure were highly suggestive of cardiac etiology.Diagnostic paracentesis was suggestive of cardiac ascites,and further cardiac evaluation showed typical signs of constrictive pericarditis.Pericardiectomy was performed followed by complete resolution of ascites.On the follow-up the patient remained symptom-free with no signs of recurrent ascites and with normal function of the liver graft.CONCLUSION Refractory ascites following liver transplantation is a rare complication with many possible causes.Broad differential diagnosis needs to be considered.

Pseudomonas aeruginosa-related effusive-constrictive pericarditis diagnosed with echocardiography:A case report

BACKGROUND Effusive-constrictive pericarditis(ECP)is an uncommon pericardial syndrome.Careful echocardiographic examination may provide helpful information not only for diagnosing but also for managing ECP.ECP has various etiologies;however,Pseudomonas aeruginosa(P.aeruginosa)infection has not been reported as a cause to date.Herein,we present a rare case of ECP caused by P.aeruginosa infection,which was followed up using echocardiography.CASE SUMMARY A 30-year-old man was admitted to our hospital with a 2-mo history of cough,dyspnea,bloating,palpitations,and lower-extremity edema.The patient was initially diagnosed with pericardial effusion by transthoracic echocardiography.Drainage of pericardial effusion was performed to relieve the clinical symptoms.A follow-up echocardiogram showed that the pericardial effusion had decreased;however,the right atrial pressure continued to increase,and signs of constrictive pericarditis were observed upon a more comprehensive inspection.Therefore,the diagnosis of ECP was established based on the comprehensive pre-and postpericardiocentesis echocardiographic findings.An urgent pericardectomy was subsequently performed,which significantly relieved the patient's clinical symptoms,and the signs of pericardial constriction on echocardiography improved.Pericardial effusion and pericardial culture showed growth of P.aeruginosa.CONCLUSION ECP induced by P.aeruginosa infection remains a rare disease.The presence of echocardiographic features of constrictive pericarditis after pericardiocentesis therapy is highly indicative of ECP.

Neuropsychiatric Systemic Lupus Erythematosus Complicated with Acute Pericarditis in Patient with Hyperprolactinaemia: A Case Report

Neuropsychiatric systemic lupus erythematosus (NP-SLE) is one of the major cause of morbidity in systemic lupus erythematosus patients and its treatment depends on identification of pathogenic mechanisms. We describe the rare case of neuropsychiatric systemic lupus erythematosus (NP-SLE) complicated by pericardial effusion combined to low C4 level persisting and hyperprolactinaemia. A cyclophosphamide therapy showed a good response in a 21-year old woman with disturbances in thought processes and an acute confusional state with sierositis. This paper confirms that a cyclophosphamide therapy contributes to control a disease activity by a mechanism of prolactin level reduction. Other studies occur to evaluate this hypothesis.

Acute pericarditis as presenting symptom of staphylococcal endocarditis: Mitral valve involvement with fistulous tract from LV to LA and subsequent pseudoaneurysm development

Acute pericarditis is an unusual presentation of bacterial endocarditis [1]. It is most commonly associated with staphylococcal aureus infection and more likely to occur in young males in association with the risk factors of alcohol or substance abuse or diabetes. Tamponade is a common presenting feature and the aortic valve is the most commonly involved valve. This condition carries a very high mortality whether treated with antibiotics alone or in combination with surgery.

Shingles and Pericarditis: A Rare Combination

Clinical infection with varicella in both its’ forms, primary and reactivation, can be associated with a variety of complications. Cardiac complications, though very rare, have been associated with the primary form of varicella zoster and as such should be recognized in order to initiate early treatment and prevent morbidity and mortality. However, cardiac complications have not been described in association with the reactivation form of varicella. We report a case of an adult immunocompetent male who presented with herpes zoster complicated by pericarditis with pericardial effusion and a positive varicella zoster virus (VZV) polymerase chain reaction (PCR) in pericardial fluid.

Cardiac tamponade due to group a streptococcal pericarditis in a 10-month-old boy and a review of the literature

Group A streptococcus (GAS) is a rare cause of purulent pericarditis in pediatric patients as only 7 cases have been reported. We present a 10-month-old boy who developed cardiac tamponade from GAS and was successfully treated with subxiphoid tube drainage and 4 weeks of antibiotics at the Children’s Hospital of Philadelphia.

“End-Stage” Constrictive Pericarditis—A Case Report

Aim: To report a case of “end-stage” constrictive pericarditis with clinical manifestations such as ascites mimicking as cirrhosis of liver. Introduction: In “End-stage” constrictive pericarditis, the etiology remains unknown in majority of cases and inflammation plays a central role in its development. It has been readily confused with cirrhosis of liver in which there may be ascites, but venous pressure is normal, the neck veins are not engorged and cardiac enlargement is frequent in other causes of heart failure. Case Report: A 67 years old male presented with sudden onset of tachycardia. Clinical examination revealed right-sided heart failure, “Egg-shell” calcification in Chest X-ray and echocardiographic features of pericardial constriction such as septal bounce and dynamic respiratory changes in mitral inflow velocity. The patient was advised medical measures. Conclusion: When clinical signs of right heart failure become unresponsive to increased doses of diuretics, constrictive pericarditis is more likely the underlying disease since severe, right-sided failure develops in very advanced, the “end-stage” of the disease.

Surgery for Aneurysmal Right Coronary Fistula and Constrictive Pericarditis in an Adult: Case Report

Coronary artery fistula (CAF) is a direct communication between a coronary artery and the lumen of any of the cardiac chambers, i.e. the coronary sinus, the pulmonary artery, the superior vena cava or the proximal pulmonary veins. The majority of these fistulas are congenital in origin although they may occasionally be detected after cardiac surgery. Congenital CAF is a rare anomaly and aneurysmal formation in the fistula is even rarer. Majority of CAFs are isolated lesions, however, congenital or acquired heart diseases may co-exist. Herein, we report a case of huge congenital aneurysmal right CAF connected to the right atrium in an Iraqi man of 62 associated with tuberculous effusive-constrictive pericarditis to whom off pump pericardiectomy was performed followed by ligation of right coronary artery and vein graft implantation to its posterior descending branch under cardiopulmonary bypass. To the best of our knowledge, such association was not previously reported. CAF can be repaired surgically with minimum risk and excellent outcome. Surgery is advised whenever coronary fistula is diagnosed unless it is very small to avoid the potential complications.