Okeke Barbara, Pocha Ciri, Rogers Lanerica, Stefanski Amber, Hendrix Christian, Lin Chien-Jung
Department of Internal Medicine, St. Louis University Hospital, St. Louis, MO, USA.
Saint Louis University School of Medicine, St. Louis, MO, USA.
J Med Cases. 2025 Apr;16(4):146-152. doi: 10.14740/jmc5124. Epub 2025 Apr 22.
Cardiac tamponade attributed to co-infection with multiple pathogens is rare. A 40-year-old man who migrated from India 10 years prior with no medical history presented with a progressive dyspnea, night sweats, intermittent fevers, weight loss over a 3-month period, and a cough. An echocardiogram revealed cardiac tamponade and further biopsy revealed necrotizing granulomas with diffuse necrotic lymphadenopathy. Early anchoring bias led to an extensive tuberculosis (TB) workup which was initially negative. However, after broadening the differential, a co-infection of tularemia and latent extrapulmonary TB was identified as the etiology of cardiac tamponade. While tularemia in the setting of immunodepression has been identified as a cause for pericarditis, there is no current literature of a tularemia and TB co-infection causing cardiac tamponade. This case highlights the importance of expanding a differential diagnosis when the presentation does not fit the diagnosis, especially when a delay in management can be consequential.
由多种病原体合并感染导致的心包填塞很少见。一名40岁男性，10年前从印度移民而来，无病史，出现进行性呼吸困难、盗汗、间歇性发热、3个月内体重减轻以及咳嗽。超声心动图显示心包填塞，进一步活检发现坏死性肉芽肿伴弥漫性坏死性淋巴结病。早期的锚定偏差导致了广泛的结核病检查，最初结果为阴性。然而，在扩大鉴别诊断范围后，发现兔热病和潜伏性肺外结核合并感染是心包填塞的病因。虽然免疫抑制情况下的兔热病已被确定为心包炎的一个病因，但目前尚无兔热病和结核病合并感染导致心包填塞的文献报道。该病例强调了在临床表现不符合诊断时扩大鉴别诊断的重要性，尤其是在治疗延迟可能产生严重后果的情况下。
