Imtiaz Haider, Hussein Mohsin, Chan Daniel, Garg Mamta
ESM, University Hospitals of Leicester NHS Trust, Leicester, UK
Radiology, University Hospitals of Leicester NHS Trust, Leicester, UK.
BMJ Case Rep. 2023 Mar 20;16(3):e254064. doi: 10.1136/bcr-2022-254064.
This report details the case of a woman in her 50s who presented with symptoms of congestive heart failure and raised inflammatory biochemical markers. Her investigations included an echocardiogram, which revealed a large pericardial effusion and a subsequent CT-thorax/abdomen/pelvis showing extensive retroperitoneal, pericardial and periaortic inflammation and soft-tissue infiltration. Genetic analysis of histopathological samples detected a V600E or V600Ec missense variant within codon 600 of the BRAF genewith BRAF variants, confirming the diagnosis of Erdheim-Chester disease (ECD).The patient's clinical management involved several treatments and interventions with input from a variety of clinical specialties. This included the cardiology team for pericardiocentesis, the cardiac surgical team for pericardiectomy due to recurrent pericardial effusions and finally the haematology team for further specialist treatment with pegylated interferon and consideration of BRAF inhibitor therapy. The patient became stable following treatment with significant improvement in her heart failure symptoms. She remains under regular joint cardiology and haematology team follow-up. The case highlighted the importance of using a multidisciplinary approach to best manage the multisystem involvement of ECD.
本报告详细介绍了一名50多岁女性的病例,该患者出现充血性心力衰竭症状且炎症生化标志物升高。她的检查包括超声心动图,结果显示大量心包积液,随后的胸部/腹部/盆腔CT显示广泛的腹膜后、心包和主动脉周围炎症及软组织浸润。对组织病理学样本进行的基因分析在BRAF基因第600密码子处检测到V600E或V600Ec错义变体,证实为 Erdheim-Chester病(ECD)。患者的临床管理涉及多种治疗和干预措施,多个临床专科参与其中。这包括心内科团队进行心包穿刺术,心脏外科团队因反复心包积液进行心包切除术,最后血液科团队进行聚乙二醇化干扰素进一步专科治疗并考虑BRAF抑制剂治疗。经过治疗,患者病情稳定,心力衰竭症状明显改善。她仍在心内科和血液科团队的定期随访中。该病例凸显了采用多学科方法来最佳管理ECD多系统受累情况的重要性。