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A rare cause of effusive-constrictive pericarditis
Andrea S Giordani1, Monica De Gaspari2, Anna Baritussio1
1Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, Padova, 35128, Italy.
ESC Heart Failure
|June 26, 2021
Summary
Effusive-constrictive pericarditis (ECP), a reversible cause of heart failure, was diagnosed in a patient with atypical mycobacteriosis. Pericardiectomy effectively treated this rare ECP presentation unresponsive to anti-inflammatory drugs.
Area of Science:
- Cardiology
- Infectious Diseases
- Pathology
Background:
- Effusive-constrictive pericarditis (ECP) is an uncommon and often missed diagnosis presenting as a reversible cause of heart failure.
- This case highlights the diagnostic challenges posed by ECP's heterogeneous clinical manifestations.
Observation:
- A 62-year-old male presented with recurrent right heart failure and pericardial effusion, initially diagnosed as idiopathic pericarditis.
- Despite indomethacin treatment, the patient relapsed with severe effusion and cardiac tamponade, necessitating pericardiocentesis.
- Cardiac catheterization confirmed ECP, with CT revealing mild pericardial thickening and inflammation without calcification.
Findings:
- Histological examination of the pericardium showed chronic non-necrotizing granulomatous inflammation.
- Polymerase chain reaction assay identified non-tuberculous mycobacteria, indicating atypical mycobacteriosis as the cause.
- This represents a rare instance of ECP caused by atypical mycobacteriosis in a non-immunocompromised patient outside an endemic area.
Implications:
- ECP diagnosis requires a high index of suspicion, especially with atypical presentations.
- Pericardiectomy is a viable treatment option for refractory ECP cases, even without significant pericardial calcification or thickening.
- Atypical mycobacterial infections should be considered in the differential diagnosis of ECP, particularly in culture-negative or treatment-resistant cases.
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