Persichino Jon, Garrison Roger, Krishnan Rajagopal, Sutjita Made
Department of Internal Medicine, Riverside University Health System Medical Center, 26520 Cactus Avenue, Moreno Valley, CA, 92555, USA.
Division of Cardiology, Riverside University Health System Medical Center, Moreno Valley, CA, USA.
BMC Infect Dis. 2016 Aug 8;16:375. doi: 10.1186/s12879-016-1752-3.
Coxsackie B is a viral pathogen that presents with various invasive diseases in adults. Historically, the majority of adult cases with pericarditis or myocarditis have been attributed to coxsackievirus B. The presentation of this viral infection causing effusive-constrictive pericarditis, hepatitis or pancreatitis is rare. This case report is the first to describe a patient with concomitant effusive-constrictive pericarditis, hepatitis and pancreatitis from possible coxsackievirus B infection.
A 26-year old female was admitted to our hospital with the diagnosis of effusive-constrictive pericarditis complicated by tamponade and cardiac arrest. An emergent pericardiocentesis was performed successfully. Hepatitis and pancreatitis were also identified in our patient. After an extensive workup, coxsackievirus B infection was suspected by positive serum complement fixation antibody titers. Our patient made a full recovery and was discharged from the hospital.
Clinical suspicion of effusive-constrictive pericarditis with tamponade from coxsackievirus B should be considered in patients presenting with chest pain, dyspnea, jugular venous distention, hypotension, ST segment elevation on electrocardiogram, and ventricular interdependence with septal shift during diastole on transthoracic echocardiogram. Initial diagnoses of effusive-constrictive pericarditis resembling cardiac tamponade, hepatitis and pancreatitis can be challenging, and this case highlights the need for healthcare professionals to be cognizant of the association between these unusual clinical presentations and coxsackievirus B infection.
柯萨奇B病毒是一种病毒病原体，可在成人中引发多种侵袭性疾病。从历史上看，大多数患有心包炎或心肌炎的成人病例都归因于柯萨奇B病毒。这种病毒感染导致渗出性缩窄性心包炎、肝炎或胰腺炎的情况较为罕见。本病例报告首次描述了一名可能因柯萨奇B病毒感染而同时患有渗出性缩窄性心包炎、肝炎和胰腺炎的患者。
一名26岁女性因诊断为渗出性缩窄性心包炎并发心包填塞和心脏骤停入院。成功进行了紧急心包穿刺术。在该患者中还发现了肝炎和胰腺炎。经过广泛检查，血清补体结合抗体滴度呈阳性，怀疑为柯萨奇B病毒感染。患者完全康复并出院。
对于出现胸痛、呼吸困难、颈静脉怒张、低血压、心电图ST段抬高以及经胸超声心动图显示舒张期室间隔移位伴心室相互依赖的患者，应考虑临床怀疑由柯萨奇B病毒引起的伴有心包填塞的渗出性缩窄性心包炎。渗出性缩窄性心包炎类似心脏填塞、肝炎和胰腺炎的初始诊断可能具有挑战性，本病例强调医疗保健专业人员需要认识到这些不寻常临床表现与柯萨奇B病毒感染之间的关联。
