Soriano Paolo K, Iqbal Muhammad, Kandaswamy Shakthishri, Akram Sami, Kulkarni Abhishek, Hudali Tamer
Department of Internal Medicine, Southern Illinois University, 751 N Rutledge, Springfield, IL 62702, USA.
Infectious Disease, Southern Illinois University, 751 N Rutledge, Springfield, IL 62702, USA.
Case Rep Cardiol. 2017;2017:3626917. doi: 10.1155/2017/3626917. Epub 2017 Sep 7.
The common causes of pericarditis and its course are benign in the majority of cases. Thus, further testing is usually not pursued and treatment for a presumptive viral etiology with nonsteroidal agents and steroids has been an accepted strategy. We present a patient with pericarditis who was unresponsive to first-line therapy and was subsequently found to have necrotizing granulomas of the pericardium with extensive adhesions and fungal elements seen on tissue biopsy. Serologic testing confirms active infection, and he responded well to Itraconazole treatment. In patients with pericarditis who fail standard therapy with NSAIDs and steroids, it is suggested that they undergo thorough evaluation and that histoplasmosis be considered as an etiology, especially in endemic regions.
心包炎的常见病因及其病程在大多数情况下是良性的。因此，通常不会进行进一步检查，采用非甾体类药物和类固醇对假定的病毒病因进行治疗一直是一种公认的策略。我们报告一名心包炎患者，其对一线治疗无反应，随后在组织活检中发现心包有坏死性肉芽肿、广泛粘连和真菌成分。血清学检测证实存在活动性感染，他对伊曲康唑治疗反应良好。对于心包炎患者，如果非甾体抗炎药和类固醇的标准治疗无效，建议对其进行全面评估，并考虑组织胞浆菌病作为病因，特别是在流行地区。
