Division of Internal Medicine, St. Luke's Roosevelt Hospital Center, University Hospital of Columbia University College of Physicians and Surgeons, NY, USA.
J Intensive Care Med. 2010 May-Jun;25(3):175-8. doi: 10.1177/0885066609358955. Epub 2010 Jan 19.
Cases of small pericardial effusion have been reported in association with dengue fever (DF), largely with dengue hemorrhagic fever during epidemic outbreaks. However, cardiac tamponade developed by a patient with DF has not yet been reported in the English literature. We report a case of cardiac tamponade in a patient with DF and lupus nephritis. We describe the characteristic features to differentiate pericardial effusion of lupus origin from that of viral etiology. A 59-year-old Hispanic woman presented to the emergency department with complaints of 5 to 6 days of fever, myalgia, headache, and retro-orbital pain. Her symptoms started 3 days after returning from the Dominican Republic, where a dengue outbreak was reported. Her past medical history was significant for hypertension and lupus nephritis diagnosed 3 months earlier. On day 2, patient developed a large pericardial effusion that progressed to tamponade over the next 2 days, requiring surgical drainage. Subsequently, the patient improved; however, serological analysis did not suggest any lupus flare-up. Pericardial fluid analysis showed hypocellularity without lupus erythematosus cell and biopsy revealed only reactive mesothelial cells suggestive of viral etiology. Dengue serology was reported as markedly elevated, supporting a diagnosis of classic DF (both immunoglobulin M [IgM] titer 2.93 and IgG titer 12.13 by enzyme-linked immunosorbent assay [ELISA]; reference range: <0.90 for both). Absence of rise in serum antinuclear antibody (ANA) titer correlated with lack of inflammatory changes on the pericardium favored viral etiology over lupus origin. This differentiation is pertinent from a management perspective.
已有文献报道与登革热（DF）相关的少量心包积液病例，主要见于流行期间的登革出血热。然而，DF 患者的心包填塞尚未在英文文献中报道。我们报告了一例 DF 和狼疮性肾炎患者的心包填塞病例。我们描述了区分狼疮性心包积液和病毒性心包积液的特征。一名 59 岁的西班牙裔妇女因发热、肌痛、头痛和眼眶后疼痛 5 至 6 天就诊于急诊科。她的症状在从报告登革热爆发的多米尼加共和国返回后 3 天开始出现。她的既往病史包括高血压和 3 个月前诊断的狼疮性肾炎。第 2 天，患者出现大量心包积液，随后 2 天进展为填塞，需要手术引流。此后，患者病情好转；然而，血清学分析并未提示狼疮活动。心包液分析显示细胞减少，无红斑狼疮细胞，活检仅显示反应性间皮细胞，提示病毒性病因。登革热血清学报告明显升高，支持典型 DF 的诊断（酶联免疫吸附试验 [ELISA] 中免疫球蛋白 M [IgM] 滴度为 2.93，IgG 滴度为 12.13；参考范围：均<0.90）。血清抗核抗体（ANA）滴度无升高与心包无炎症变化相关，提示病毒性病因而非狼疮性病因。从管理角度来看，这种区分很重要。
