Non-typhoid Salmonella is a common foodborne infection.[1]In the setting of immunosuppression,the classical symptom of diarrhea,that is an immune defense mechanism,may be absent,[2,3]allowing the bacteria to hematogen...Non-typhoid Salmonella is a common foodborne infection.[1]In the setting of immunosuppression,the classical symptom of diarrhea,that is an immune defense mechanism,may be absent,[2,3]allowing the bacteria to hematogenous spread and settle in other organs.[4,5]As a result,in the setting of acute pericarditis in immunosuppressed patients,a bacterial etiology must always be considered,which requires pericardiocentesis to complete drainage and pathogen identification.展开更多
BACKGROUND Pericarditis is the inflammation of the pericardial sac due to a variety of stimuli that ultimately trigger a stereotyped immune response.This condition accounts for up to 5%of emergency department visits f...BACKGROUND Pericarditis is the inflammation of the pericardial sac due to a variety of stimuli that ultimately trigger a stereotyped immune response.This condition accounts for up to 5%of emergency department visits for nonischemic chest pain in Western Europe and North America.The most common symptoms of clinical presentation are chest pain and shortness of breath with associated unique electrocardiographic changes.Acute pericarditis is generally self-limited.However,some cases may be complicated by either tamponade or a large pericardial effusion,which carries a significant risk of recurrence.Risk factors for acute pericarditis include viral infections,cardiac surgery,and autoimmune disorders.A rarer cause of pericardial inflammation includes pneumonia,which can induce purulent pericarditis that has been increasingly rare since the advent of antibiotics.Purulent pericarditis carries a high fatality rate,especially in the setting of tamponade,and is invariably deadly without the administration of antibiotics.Bedside transthoracic echocardiogram is a quick and helpful method that can aid in the diagnosis and management.CASE SUMMARY We present the case of a 62-year-old woman who sought medical attention at the emergency department(ED)due to a 5-day history of chest pain,shortness of breath,and subjective fevers.Laboratory findings in the ED were significant for leukocytosis and elevated erythrocyte sedimentation rate and C-reactive protein.A chest X-ray revealed a new focal density within the left lower lung base,and a bedside point-of-care ultrasound showed a pericardial fluid collection.The patient was subsequently admitted,where she underwent pericardiocentesis.Fluid cultures from drainage grew streptococcus pneumoniae.She was started on broadspectrum antibiotics immediately after the procedure.The patient was ultimately discharged in stable condition with cardiology and infectious disease follow-up.CONCLUSION This case report emphasizes a unique complication of community-acquired pneumonia.Purulent pericarditis due to streptococcus pneumonia occurs via intrathoracic spread of the organism to the pericardium.This condition is virtually fatal without the administration of antibiotics.Therefore,in the context of suspected pneumonia and a new pericardial fluid collection on imaging,clinicians should suspect purulent pericarditis until proven otherwise,which requires emergent intervention.展开更多
BACKGROUND The integration of sophisticated large language models(LLMs)into healthcare has recently garnered significant attention due to their ability to leverage deep learning techniques to process vast datasets and...BACKGROUND The integration of sophisticated large language models(LLMs)into healthcare has recently garnered significant attention due to their ability to leverage deep learning techniques to process vast datasets and generate contextually accurate,human-like responses.These models have been previously applied in medical diagnostics,such as in the evaluation of oral lesions.Given the high rate of missed diagnoses in pericarditis,LLMs may support clinicians in generating differential diagnoses-particularly in atypical cases where risk stratification and early identi-fication are critical to preventing serious complications such as constrictive pericarditis and pericardial tamponade.AIM To compare the accuracy of LLMs in assisting the diagnosis of pericarditis as risk stratification tools.METHODS A PubMed search was conducted using the keyword“pericarditis”,applying filters for“case reports”.Data from relevant cases were extracted.Inclusion criteria consisted of English-language reports involving patients aged 18 years or older with a confirmed diagnosis of acute pericarditis.The diagnostic capabilities of ChatGPT o1 and DeepThink-R1 were assessed by evaluating whether pericarditis was included in the top three differential diagnoses and as the sole provisional diagnosis.Each case was classified as either“yes”or“no”for inclusion.RESULTS From the initial search,220 studies were identified,of which 16 case reports met the inclusion criteria.In assessing risk stratification for acute pericarditis,ChatGPT o1 correctly identified the condition in 10 of 16 cases(62.5%)in the differential diagnosis and in 8 of 16 cases(50.0%)as the provisional diagnosis.DeepThink-R1 identified it in 8 of 16 cases(50.0%)and 6 of 16 cases(37.5%),respectively.ChatGPT o1 demonstrated higher accuracy than DeepThink-R1 in identifying pericarditis.CONCLUSION Further research with larger sample sizes and optimized prompt engineering is warranted to improve diagnostic accuracy,particularly in atypical presentations.展开更多
Left atrial aneurysm is an exceptionally rare condition,particularly in the pediatric population,and even more so as a sequela of bacterial pericarditis.We present the case of a 16-month-old girl who developed a left ...Left atrial aneurysm is an exceptionally rare condition,particularly in the pediatric population,and even more so as a sequela of bacterial pericarditis.We present the case of a 16-month-old girl who developed a left atrial aneurysm following isolated Staphylococcus aureus pericarditis.She initially presented in decompensated shock and was later diagnosed with constrictive pericarditis.Despite undergoing pericardiectomy,she subsequently developed a left atrial aneurysm,necessitating surgical closure.This case highlights the aggressive nature of bacterial pericarditis and its potential to cause rare structural cardiac complications.展开更多
Rationale:Synthetic cannabinoids are increasingly used as recreational drugs and have been associated with adverse cardiovascular effects.However,reports of synthetic cannabinoids accompanied by constrictive pericardi...Rationale:Synthetic cannabinoids are increasingly used as recreational drugs and have been associated with adverse cardiovascular effects.However,reports of synthetic cannabinoids accompanied by constrictive pericarditis are limited.Patient’s concern:A 28-year-old male with a history of synthetic cannabinoid(Bonzai)abuse presented with chest discomfort,dyspnea,and lower extremity edema.Investigations revealed reduced left ventricular ejection fraction,elevated inflammatory markers,low electrocardiogram voltages,and atrial fibrillation.Diagnosis:Chest spiral computerized tomography scan and chest X-ray demonstrated pericardial calcification.Cardiac magnetic resonance imaging and right heart catheterization were done to confirm the possibility of constrictive pericarditis.Based on the patient’s addiction history and exclusion of rheumatologic and infectious causes,it was supposed that constrictive pericarditis and cardiomyopathy may be accompanied by synthetic cannabinoid use.Interventions:The patient received standard medical therapy,including loop diuretics for cardiomyopathy and constrictive pericarditis.Catheter ablation was recommended for his rhythm control,and he was planned for close monitoring of clinical and echocardiographic response and evaluation of the need for surgical pericardiectomy in the future.Outcomes:After 6 months follow-up,echocardiographic exam revealed no significant improvement in ventricular function.However,due to the high surgical risk,the patient’s poor compliance,and the continuation of drug abuse,he was not a good candidate for surgery according to our heart team’s decision.Lessons:Synthetic cannabinoids can trigger constrictive pericarditis,and clinicians should consider them when evaluating patients with compatible symptoms and exposure history.Further research on the cardiovascular effects of synthetic cannabinoids is needed and public education on potential harms is warranted.展开更多
Introduction: Pericarditis is an inflammation of the pericardium with or without pericardial fluid effusion. Its prevalence is difficult to determine given the many forms that are not symptomatic. In Africa, its preva...Introduction: Pericarditis is an inflammation of the pericardium with or without pericardial fluid effusion. Its prevalence is difficult to determine given the many forms that are not symptomatic. In Africa, its prevalence was 6.3% in Gabon in 2020 and 7.2% in Mali in 2022. In Europe, an Italian study estimates the incidence of acute pericarditis at 27.7 cases per 100,000 people per year. In another study conducted in Finland over a period of 9 years, the incidence of pericarditis requiring hospitalisation was 3.32 cases per 100,000 people per year. The aim of our study was to describe the clinical and paraclinical characteristics of pericarditis observed in the cardiology department of the regional hospital in Mali. Methodology: This was a single centre cross-sectional study from 30 January 2018 to 30 June 2020 in the cardiology department of the Ségou regional hospital. All consenting patients, regardless of age or sex hospitalised in the department for pericarditis confirmed on cardiac ultrasound were included. Data were collected using an individual patient follow-up form recording sociodemographic, clinical, biological, electrocardiographic and echocardiographic data, as well as the course of the disease. Results: Out of 879 patients hospitalized, the hospital frequency was 7.28%. Females predominated, with a sex ratio of 0.42. More than half the patients were aged 45 or younger (59.4%). The mean age of patients was 41.8 ± 18.1 years. Cardiovascular risk factors were dominated by hypertension and smoking (46.9% and 12.5% respectively). The reasons for consultation were dyspnoea (84.3%), chest pain (54.7%), cough (71.9%) and fever (34.4%). Physical signs included muffled heart sounds (76.6%), tachycardia (70.3%), pericardial friction (17.2%) and signs of peripheral stasis in 53.1% of cases. We observed elevated C-reactive protein (CRP) in 57.8% of cases, hypercreatininaemia in 37.5% and positive HIV serology in 3.1%. The major radiographic signs were cardiomegaly in 82.8% and pleural effusion in 37.5%. On electrocardiogram (ECG), 51.6% of patients had a repolarisation disorder and sinus tachycardia;34.4% had QRS microvoltage. Echocardiography revealed tamponade in 1.6% and pericardial effusion in 100%. The effusion was very large in 17.3% of cases. The pericardial fluid was citrine yellow in 18.8%, serosanguineous in 9.4% and haemorrhagic in 7.8%. The aetiology of the pericarditis was idiopathic in 42.1% and secondary to HIV in 3.1%. Transudative fluid was observed in 16.5% of cases. The outcome was generally favourable, with 92.2% of cases cured, but 1.6% with persistent effusion, 3.1% with recurrence, and 3.1% with mortality.展开更多
Introduction: Uremic pericarditis is a major complication of renal disease, occurring in patients with chronic renal failure, prior to dialysis or during dialysis treatment. Our aim was to determine the prevalence and...Introduction: Uremic pericarditis is a major complication of renal disease, occurring in patients with chronic renal failure, prior to dialysis or during dialysis treatment. Our aim was to determine the prevalence and clinique aspect of uremic pericarditis in our center. Material and Methods: This was a dynamic descriptive study covering the period from August 1 to March 30, 2022. Recruitment was exhaustive of all chronic hemodialysis patients over three months of age, and only those presenting with uremic pericarditis after our means of investigation were included in the study. The sample size was obtained after counting and showed a total of 47 patients with uremic pericarditis. Data were entered and analyzed in SPSS v21. Results: The prevalence of uremic pericarditis in this study was 17.54%;the mean age of patients was 34.42 ± 12.38 years;vascular nephropathy accounted for 57.45% of cases;clinical signs were dominated by pericardial friction (91.50%) and liquid pericarditis (89.36%);more than half of patients (93.62%) received two hemodialysis sessions per week. Late discovery of CKD was 74.47%. The mortality rate in this study was 34.04%. There was no statistically significant association between late onset of CKD and uremic pericarditis (p-value = 0.59). Conclusion: Late diagnosis of CKD is often accompanied by serious complications, including uremic pericarditis, which is responsible for early morbidity and mortality in new hemodialysis patients.展开更多
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 ...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.展开更多
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 infectio...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.展开更多
Cytomegalovirus (CMV) infection in inmunocompetent hosts generally is asymptomatic or may present as a mononucleosis syndrome but rarely can lead to severe organ complications. We report a case of simultaneous hepatic...Cytomegalovirus (CMV) infection in inmunocompetent hosts generally is asymptomatic or may present as a mononucleosis syndrome but rarely can lead to severe organ complications. We report a case of simultaneous hepatic and pericardic CMV infection in a 36-year old immunocompetent man. He was admitted to coronary unit with fever, chest pain radiated to shoulders, changes on electrocardiogram with diffuse ST elevation and modest laboratory elevations in the MB fraction of creatine kinase (CK-MB) of 33.77 μg/L (0.1-6.73), serum cardiac troponin T of 0.904 ng/mL (0-0.4), creatine kinase of 454 U/L (20-195) and myoglobin of 480.4 μg/L (28-72). Routine laboratory test detected an elevation of aminotransferase level: alanine aminotransferase 1445 U/L, aspartate aminotransferase 601 U/L. We ruled out other causes of hepatitis with normal results except IgM CMV. The patient was diagnosed with myopericarditis and hepatitis caused by cytomegalovirus and started symptomatic treatment with salicylic acid. In few days the laboratory findings became normal and the patient was discharged.展开更多
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 ...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.展开更多
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 t...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.展开更多
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 hepatiti...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.展开更多
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 ...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.展开更多
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 presente...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.展开更多
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 inte...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.展开更多
A case of strangulation of the transverse colon in a traumatic left diaphragmatic hernia manifesting as pericarditis is reported. This is unusual because pericardial signs in traumatic diaphragmatic hernia have been p...A case of strangulation of the transverse colon in a traumatic left diaphragmatic hernia manifesting as pericarditis is reported. This is unusual because pericardial signs in traumatic diaphragmatic hernia have been previously described in association with direct pericardial injury. This is the only such case where electrocardiographic changes of pericarditis were seen without direct pericardial trauma. The possibility of internal herniation through a traumatic diaphragmatic hernia must be considered in patients with chest symptoms and a compatible history.展开更多
AIM To conduct a review of "interferon related pericarditis". METHODS We searched MEDLINE, EMBASE, Cinahl, and the Co-chrane Database from the earliest available date through September 2016. A search strateg...AIM To conduct a review of "interferon related pericarditis". METHODS We searched MEDLINE, EMBASE, Cinahl, and the Co-chrane Database from the earliest available date through September 2016. A search strategy using the Medical Subject Headings and text keywords "interferon" and "pericarditis" were used. RESULTS Nine case reports were eligible for the present study. Six of 8 cases were women and the mean age was 43.8 ± 13.8 years with chronic hepatitis C in 6 cases, malignant melanoma in 2 cases and chronic myelogenous leukemia in 1 case. The patients complained of chest pain in 6 cases, dyspnea in 5 cases and edema in 2 cases. Pericardial friction rub was heard in 3 of 9 cases. Congestive heart failure occurred in 3 of 9 cases. Two mechanisms for pericarditis were demonstrated, one is autoimmune included lupus like syndrome in 2 cases and the other is cardio toxicity in 4 cases. Treatment of interferon related pericarditis is discontinuation of Interferon treatment. Four of 9 cases were treated with prednisone and 4 with nonsteroidal anti-inflammatory drugs. CONCLUSION Interferon related pericarditis still remains uncertain. Treatment of interferon related pericarditis rests mainly on early recognition and drug discontinuation. Interferon related pericarditis was treated with steroid and/or nonsteroidal anti-inflammatory drugs.展开更多
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 se...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.展开更多
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 af...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.展开更多
文摘Non-typhoid Salmonella is a common foodborne infection.[1]In the setting of immunosuppression,the classical symptom of diarrhea,that is an immune defense mechanism,may be absent,[2,3]allowing the bacteria to hematogenous spread and settle in other organs.[4,5]As a result,in the setting of acute pericarditis in immunosuppressed patients,a bacterial etiology must always be considered,which requires pericardiocentesis to complete drainage and pathogen identification.
文摘BACKGROUND Pericarditis is the inflammation of the pericardial sac due to a variety of stimuli that ultimately trigger a stereotyped immune response.This condition accounts for up to 5%of emergency department visits for nonischemic chest pain in Western Europe and North America.The most common symptoms of clinical presentation are chest pain and shortness of breath with associated unique electrocardiographic changes.Acute pericarditis is generally self-limited.However,some cases may be complicated by either tamponade or a large pericardial effusion,which carries a significant risk of recurrence.Risk factors for acute pericarditis include viral infections,cardiac surgery,and autoimmune disorders.A rarer cause of pericardial inflammation includes pneumonia,which can induce purulent pericarditis that has been increasingly rare since the advent of antibiotics.Purulent pericarditis carries a high fatality rate,especially in the setting of tamponade,and is invariably deadly without the administration of antibiotics.Bedside transthoracic echocardiogram is a quick and helpful method that can aid in the diagnosis and management.CASE SUMMARY We present the case of a 62-year-old woman who sought medical attention at the emergency department(ED)due to a 5-day history of chest pain,shortness of breath,and subjective fevers.Laboratory findings in the ED were significant for leukocytosis and elevated erythrocyte sedimentation rate and C-reactive protein.A chest X-ray revealed a new focal density within the left lower lung base,and a bedside point-of-care ultrasound showed a pericardial fluid collection.The patient was subsequently admitted,where she underwent pericardiocentesis.Fluid cultures from drainage grew streptococcus pneumoniae.She was started on broadspectrum antibiotics immediately after the procedure.The patient was ultimately discharged in stable condition with cardiology and infectious disease follow-up.CONCLUSION This case report emphasizes a unique complication of community-acquired pneumonia.Purulent pericarditis due to streptococcus pneumonia occurs via intrathoracic spread of the organism to the pericardium.This condition is virtually fatal without the administration of antibiotics.Therefore,in the context of suspected pneumonia and a new pericardial fluid collection on imaging,clinicians should suspect purulent pericarditis until proven otherwise,which requires emergent intervention.
文摘BACKGROUND The integration of sophisticated large language models(LLMs)into healthcare has recently garnered significant attention due to their ability to leverage deep learning techniques to process vast datasets and generate contextually accurate,human-like responses.These models have been previously applied in medical diagnostics,such as in the evaluation of oral lesions.Given the high rate of missed diagnoses in pericarditis,LLMs may support clinicians in generating differential diagnoses-particularly in atypical cases where risk stratification and early identi-fication are critical to preventing serious complications such as constrictive pericarditis and pericardial tamponade.AIM To compare the accuracy of LLMs in assisting the diagnosis of pericarditis as risk stratification tools.METHODS A PubMed search was conducted using the keyword“pericarditis”,applying filters for“case reports”.Data from relevant cases were extracted.Inclusion criteria consisted of English-language reports involving patients aged 18 years or older with a confirmed diagnosis of acute pericarditis.The diagnostic capabilities of ChatGPT o1 and DeepThink-R1 were assessed by evaluating whether pericarditis was included in the top three differential diagnoses and as the sole provisional diagnosis.Each case was classified as either“yes”or“no”for inclusion.RESULTS From the initial search,220 studies were identified,of which 16 case reports met the inclusion criteria.In assessing risk stratification for acute pericarditis,ChatGPT o1 correctly identified the condition in 10 of 16 cases(62.5%)in the differential diagnosis and in 8 of 16 cases(50.0%)as the provisional diagnosis.DeepThink-R1 identified it in 8 of 16 cases(50.0%)and 6 of 16 cases(37.5%),respectively.ChatGPT o1 demonstrated higher accuracy than DeepThink-R1 in identifying pericarditis.CONCLUSION Further research with larger sample sizes and optimized prompt engineering is warranted to improve diagnostic accuracy,particularly in atypical presentations.
文摘Left atrial aneurysm is an exceptionally rare condition,particularly in the pediatric population,and even more so as a sequela of bacterial pericarditis.We present the case of a 16-month-old girl who developed a left atrial aneurysm following isolated Staphylococcus aureus pericarditis.She initially presented in decompensated shock and was later diagnosed with constrictive pericarditis.Despite undergoing pericardiectomy,she subsequently developed a left atrial aneurysm,necessitating surgical closure.This case highlights the aggressive nature of bacterial pericarditis and its potential to cause rare structural cardiac complications.
文摘Rationale:Synthetic cannabinoids are increasingly used as recreational drugs and have been associated with adverse cardiovascular effects.However,reports of synthetic cannabinoids accompanied by constrictive pericarditis are limited.Patient’s concern:A 28-year-old male with a history of synthetic cannabinoid(Bonzai)abuse presented with chest discomfort,dyspnea,and lower extremity edema.Investigations revealed reduced left ventricular ejection fraction,elevated inflammatory markers,low electrocardiogram voltages,and atrial fibrillation.Diagnosis:Chest spiral computerized tomography scan and chest X-ray demonstrated pericardial calcification.Cardiac magnetic resonance imaging and right heart catheterization were done to confirm the possibility of constrictive pericarditis.Based on the patient’s addiction history and exclusion of rheumatologic and infectious causes,it was supposed that constrictive pericarditis and cardiomyopathy may be accompanied by synthetic cannabinoid use.Interventions:The patient received standard medical therapy,including loop diuretics for cardiomyopathy and constrictive pericarditis.Catheter ablation was recommended for his rhythm control,and he was planned for close monitoring of clinical and echocardiographic response and evaluation of the need for surgical pericardiectomy in the future.Outcomes:After 6 months follow-up,echocardiographic exam revealed no significant improvement in ventricular function.However,due to the high surgical risk,the patient’s poor compliance,and the continuation of drug abuse,he was not a good candidate for surgery according to our heart team’s decision.Lessons:Synthetic cannabinoids can trigger constrictive pericarditis,and clinicians should consider them when evaluating patients with compatible symptoms and exposure history.Further research on the cardiovascular effects of synthetic cannabinoids is needed and public education on potential harms is warranted.
文摘Introduction: Pericarditis is an inflammation of the pericardium with or without pericardial fluid effusion. Its prevalence is difficult to determine given the many forms that are not symptomatic. In Africa, its prevalence was 6.3% in Gabon in 2020 and 7.2% in Mali in 2022. In Europe, an Italian study estimates the incidence of acute pericarditis at 27.7 cases per 100,000 people per year. In another study conducted in Finland over a period of 9 years, the incidence of pericarditis requiring hospitalisation was 3.32 cases per 100,000 people per year. The aim of our study was to describe the clinical and paraclinical characteristics of pericarditis observed in the cardiology department of the regional hospital in Mali. Methodology: This was a single centre cross-sectional study from 30 January 2018 to 30 June 2020 in the cardiology department of the Ségou regional hospital. All consenting patients, regardless of age or sex hospitalised in the department for pericarditis confirmed on cardiac ultrasound were included. Data were collected using an individual patient follow-up form recording sociodemographic, clinical, biological, electrocardiographic and echocardiographic data, as well as the course of the disease. Results: Out of 879 patients hospitalized, the hospital frequency was 7.28%. Females predominated, with a sex ratio of 0.42. More than half the patients were aged 45 or younger (59.4%). The mean age of patients was 41.8 ± 18.1 years. Cardiovascular risk factors were dominated by hypertension and smoking (46.9% and 12.5% respectively). The reasons for consultation were dyspnoea (84.3%), chest pain (54.7%), cough (71.9%) and fever (34.4%). Physical signs included muffled heart sounds (76.6%), tachycardia (70.3%), pericardial friction (17.2%) and signs of peripheral stasis in 53.1% of cases. We observed elevated C-reactive protein (CRP) in 57.8% of cases, hypercreatininaemia in 37.5% and positive HIV serology in 3.1%. The major radiographic signs were cardiomegaly in 82.8% and pleural effusion in 37.5%. On electrocardiogram (ECG), 51.6% of patients had a repolarisation disorder and sinus tachycardia;34.4% had QRS microvoltage. Echocardiography revealed tamponade in 1.6% and pericardial effusion in 100%. The effusion was very large in 17.3% of cases. The pericardial fluid was citrine yellow in 18.8%, serosanguineous in 9.4% and haemorrhagic in 7.8%. The aetiology of the pericarditis was idiopathic in 42.1% and secondary to HIV in 3.1%. Transudative fluid was observed in 16.5% of cases. The outcome was generally favourable, with 92.2% of cases cured, but 1.6% with persistent effusion, 3.1% with recurrence, and 3.1% with mortality.
文摘Introduction: Uremic pericarditis is a major complication of renal disease, occurring in patients with chronic renal failure, prior to dialysis or during dialysis treatment. Our aim was to determine the prevalence and clinique aspect of uremic pericarditis in our center. Material and Methods: This was a dynamic descriptive study covering the period from August 1 to March 30, 2022. Recruitment was exhaustive of all chronic hemodialysis patients over three months of age, and only those presenting with uremic pericarditis after our means of investigation were included in the study. The sample size was obtained after counting and showed a total of 47 patients with uremic pericarditis. Data were entered and analyzed in SPSS v21. Results: The prevalence of uremic pericarditis in this study was 17.54%;the mean age of patients was 34.42 ± 12.38 years;vascular nephropathy accounted for 57.45% of cases;clinical signs were dominated by pericardial friction (91.50%) and liquid pericarditis (89.36%);more than half of patients (93.62%) received two hemodialysis sessions per week. Late discovery of CKD was 74.47%. The mortality rate in this study was 34.04%. There was no statistically significant association between late onset of CKD and uremic pericarditis (p-value = 0.59). Conclusion: Late diagnosis of CKD is often accompanied by serious complications, including uremic pericarditis, which is responsible for early morbidity and mortality in new hemodialysis patients.
文摘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.
文摘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.
文摘Cytomegalovirus (CMV) infection in inmunocompetent hosts generally is asymptomatic or may present as a mononucleosis syndrome but rarely can lead to severe organ complications. We report a case of simultaneous hepatic and pericardic CMV infection in a 36-year old immunocompetent man. He was admitted to coronary unit with fever, chest pain radiated to shoulders, changes on electrocardiogram with diffuse ST elevation and modest laboratory elevations in the MB fraction of creatine kinase (CK-MB) of 33.77 μg/L (0.1-6.73), serum cardiac troponin T of 0.904 ng/mL (0-0.4), creatine kinase of 454 U/L (20-195) and myoglobin of 480.4 μg/L (28-72). Routine laboratory test detected an elevation of aminotransferase level: alanine aminotransferase 1445 U/L, aspartate aminotransferase 601 U/L. We ruled out other causes of hepatitis with normal results except IgM CMV. The patient was diagnosed with myopericarditis and hepatitis caused by cytomegalovirus and started symptomatic treatment with salicylic acid. In few days the laboratory findings became normal and the patient was discharged.
文摘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.
基金Supported by The University of Cape Town’s Research Committee(URC)the South African National Research Foundation(NRF)
文摘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.
文摘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.
文摘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.
文摘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.
文摘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.
文摘A case of strangulation of the transverse colon in a traumatic left diaphragmatic hernia manifesting as pericarditis is reported. This is unusual because pericardial signs in traumatic diaphragmatic hernia have been previously described in association with direct pericardial injury. This is the only such case where electrocardiographic changes of pericarditis were seen without direct pericardial trauma. The possibility of internal herniation through a traumatic diaphragmatic hernia must be considered in patients with chest symptoms and a compatible history.
文摘AIM To conduct a review of "interferon related pericarditis". METHODS We searched MEDLINE, EMBASE, Cinahl, and the Co-chrane Database from the earliest available date through September 2016. A search strategy using the Medical Subject Headings and text keywords "interferon" and "pericarditis" were used. RESULTS Nine case reports were eligible for the present study. Six of 8 cases were women and the mean age was 43.8 ± 13.8 years with chronic hepatitis C in 6 cases, malignant melanoma in 2 cases and chronic myelogenous leukemia in 1 case. The patients complained of chest pain in 6 cases, dyspnea in 5 cases and edema in 2 cases. Pericardial friction rub was heard in 3 of 9 cases. Congestive heart failure occurred in 3 of 9 cases. Two mechanisms for pericarditis were demonstrated, one is autoimmune included lupus like syndrome in 2 cases and the other is cardio toxicity in 4 cases. Treatment of interferon related pericarditis is discontinuation of Interferon treatment. Four of 9 cases were treated with prednisone and 4 with nonsteroidal anti-inflammatory drugs. CONCLUSION Interferon related pericarditis still remains uncertain. Treatment of interferon related pericarditis rests mainly on early recognition and drug discontinuation. Interferon related pericarditis was treated with steroid and/or nonsteroidal anti-inflammatory drugs.
文摘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.
文摘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.
