Qureshi Nada Qaisar, Foley Jeffrey, Mufarrih Syed Hamza, Kazimuddin Mohammed
Department of Medicine, University of Kentucky, Bowling Green, KY, USA.
Department of Cardiology, Western Kentucky Heart and Lung, Bowling Green, KY, USA.
J Cardiol Cases. 2023 Oct 25;29(1):35-38. doi: 10.1016/j.jccase.2023.10.002. eCollection 2024 Jan.
infection is infrequently considered in the differential diagnoses for acute pericarditis in immunocompetent hosts when presenting with tamponade physiology, given its gradual infective nature. We describe a case of a young male presenting solely with acute pericarditis with pericardial effusion and early cardiac tamponade physiology secondary to a pulmonary histoplasmosis infection. Our patient had no pulmonary symptoms; the only pulmonary manifestation of histoplasmosis included incidental findings of subcarinal lymphadenopathy and a left lingular nodule abutting the pericardium. Given failure of symptom improvement with pericardiocentesis and first-line therapy for idiopathic/viral pericarditis, further workup of the pulmonary nodule was pursued. Histopathologic analysis of tissue showed caseating granulomas and fungal Grocott-Gömöri's methenamine silver stain revealed yeast consistent with species. The patient improved with itraconazole therapy.
Pulmonary histoplasmosis has potential to present as a pericardial effusion in the immunocompetent individual. In addition to pericardiocentesis, antifungal therapy can be curative.
在免疫功能正常的宿主中，当出现心脏压塞生理表现时，由于感染具有渐进性，在急性心包炎的鉴别诊断中很少考虑感染因素。我们描述了一例年轻男性病例，该患者仅表现为急性心包炎伴心包积液和早期心脏压塞生理表现，继发于肺组织胞浆菌病感染。我们的患者没有肺部症状；组织胞浆菌病唯一的肺部表现包括隆突下淋巴结肿大和紧邻心包的左舌叶结节的偶然发现。由于心包穿刺术和特发性/病毒性心包炎一线治疗未能改善症状，因此对肺部结节进行了进一步检查。组织病理分析显示干酪样肉芽肿，真菌Grocott-Gömöri六胺银染色显示酵母符合相关菌种。患者接受伊曲康唑治疗后病情好转。
肺组织胞浆菌病有可能在免疫功能正常的个体中表现为心包积液。除心包穿刺术外，抗真菌治疗可能治愈。
