Subramanian Stalin R, Akram Rakhshanda, Velayati Arash, Chadow Hal
Department of Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA.
BMJ Case Rep. 2013 Jul 12;2013:bcr2013010254. doi: 10.1136/bcr-2013-010254.
A 40-year-old man with a medical history of hypertension was admitted for weight loss, generalised weakness, joint pains and mottling of fingertips. The initial laboratory data revealed microangiopathic haemolytic anaemia, thrombocytopenia and acute renal failure. Intravenous steroids were started for possible diagnosis of systemic lupus erythematosus based on admission assessment. Intravenous immunoglobulin and plasmapharesis were subsequently added to the treatment plan to cover thrombotic thrombocytopenic purpura while his autoimmune panel was pending. The echocardiogram study on day 2 revealed cardiac tamponade for which he underwent pericardiocentesis and right heart catheterisation. The atrial waveforms postpericardiocentesis demonstrated effusive-constrictive pericarditis. His clinical condition kept on deteriorating with reaccumulation of pericardial effusion and further complicated by hemoperitoneum and colonic obstruction. He had cardiorespiratory arrest on his fourth admission day and was not revived. Anti-Scl-70 antibody came back positive. Autopsy findings confirmed the presence of fibrinous pericarditis and hemoperitoneum.
一名有高血压病史的40岁男性因体重减轻、全身无力、关节疼痛和指尖斑驳入院。初始实验室检查数据显示微血管病性溶血性贫血、血小板减少和急性肾衰竭。基于入院评估，开始静脉注射类固醇，以可能诊断系统性红斑狼疮。随后在自身免疫指标结果未出时，将静脉注射免疫球蛋白和血浆置换加入治疗方案，以涵盖血栓性血小板减少性紫癜。第2天的超声心动图检查显示心包填塞，为此他接受了心包穿刺术和右心导管检查。心包穿刺术后的心房波形显示为渗出性缩窄性心包炎。他的临床状况不断恶化，心包积液再次积聚，并进一步并发血腹和结肠梗阻。他在第四次入院日发生心肺骤停，未能复苏。抗Scl-70抗体呈阳性。尸检结果证实存在纤维蛋白性心包炎和血腹。
