Concomitant methicillin‐resistant Staphylococcus aureus pericaditis,Cryptococcus neoformans pneumonia and invasive cytomegalovirus pneumonitis in a lupus patient with rare homozygous structural mutant variant at codon 54 of mannose binding lectin gene

Mannose‐binding lectin (MBL) is a mediator of innate immunity. Individuals with exon 1 structural mutant genotypes are associated with unusual and recurrent infections. We describe a lupus patient who had life‐threatening, concomitant infections – methicillin‐resistant staphylococcal aureus (MRSA) pericarditis with tamponade, cryptococcal pneumonia and cytomegalovirus (CMV) pneumonitis. Tests were negative for complements or immunoglobulins deficiencies. There was no human immunodeficiency virus (HIV) infection. She has a homozygous structural mutant variant at codon 54 of the MBL gene. We surmised the severe multiple infections are related to this rare mutant variant, and may be triggered off by corticosteroid therapy.     

Inadvertent thrombolytic therapy for cardiovascular diseases masquerading as acute coronary thrombosis

We report three cases of inadvertent thrombolytic administration to patients with cardiovascular diagnoses masquerading as acute coronary thrombosis presenting to a tertiary care private hospital. Despite a final diagnosis of myocarditis, aortic dissection, and pericarditis, the initial presentation and electrocardiogram were believed to indicate an acute myocardial infarction due to coronary thrombosis. Intravenous thrombolytic agents were administered early in their presentation. Cardiac catheterization in two of the patients revealed normal coronary arteriography and in the third patient confirmed an aortic dissection. The patient with an aortic dissection died while the other two recovered without adverse consequences of the thrombolytic agents. Prior reports of five patients, treated with intravenous thrombolytic agents for suspected coronary thrombosis, who proved to have a final diagnosis of pericarditis or aortic dissection are reviewed. Death or tamponade occurred in four of five. The consequences of inadvertently administering intravenous thrombolytic agents to patients with nonthrombotic cardiac disorders can be serious. If the diagnosis of acute myocardial infarction due to coronary thrombosis is uncertain, serial electrocardiograms, bedside echocardiography, or urgent cardiac catheterization may be appropriate before administering these agents.     

P-wave terminal force in lead V1 is a predictive indicator for the diagnosis of tuberculous constrictive pericarditis

Objectives

The purpose of this study is to explore the value of P-wave terminal force in lead V1 (PTFV1) in the clinical diagnosis of tuberculous constrictive pericarditis (TCP).

Predictive factors of recurrence after pediatric acute pericarditis

ObjectiveThe predisposing factors for pericarditis recurrence in the pediatric population have not yet been established. This study aimed to define the risk factors for the unfavorable prognosis of pediatric acute pericarditis.MethodsThis was a retrospective study that included all patients with acute pericarditis treated from 2011 to 2019 at a tertiary referent pediatric center.ResultsThe study included 72 children. Recurrence was observed in 22.2% patients. Independent risk factors for recurrence were: erythrocyte sedimentation rate ≥ 50 mm/h (p = 0.003, OR 186.3), absence of myocarditis (p = 0.05, OR 15.2), C-reactive protein ≥ 125 mg/L (p = 0.04, OR 1.5), and non-idiopathic etiology pericarditis (p = 0.003, OR 1.3). Corticosteroid treatment in acute pericarditis was associated with a higher recurrence rate than treatment with non-steroid anti-inflammatory therapy (p = 0.04). Furthermore, patients treated with colchicine in the primary recurrence had lower recurrence rate and median number of repeated infections than those treated without colchicine (p = 0.04; p = 0.007, respectively).ConclusionIndependent risk factors for recurrence are absence of myocarditis, non-idiopathic etiology pericarditis, C-reactive protein ≥ 125 mg/L, and erythrocyte sedimentation rate ≥ 50 mm/h. Acute pericarditis should be treated with non-steroid anti-inflammatory therapy. A combination of colchicine and non-steroid anti-inflammatory drugs could be recommended as the treatment of choice in recurrent pericarditis.     

Scedosporium prolificans pericarditis and mycotic aortic aneurysm in a lung transplant recipient receiving voriconazole prophylaxis

Despite the adoption of antifungal prophylaxis, fungal infections remain a significant concern in lung transplant recipients. Indeed, some concern exists that such prophylaxis may increase the risk of infection with drug‐resistant fungal organisms. Here, we describe a case of disseminated Scedosporium prolificans infection, presenting as pericarditis, which developed in a lung transplant patient receiving prophylactic voriconazole for 8 months. The epidemiology and clinical presentation of S. prolificans infections are reviewed, and controversies surrounding antifungal prophylaxis and the development of resistant infections are discussed.     

Multimodality imaging for the diagnosis and treatment of constrictive pericarditis

ABSTRACT

Introduction: Constrictive pericarditis can result in debilitating congestive right heart failure and has been considered an important cause of morbidity and mortality in patients with cardiovascular disease. Multimodality imaging continues to play a fundamental role in the individual approach to diagnosis, management, and prognosis of patients with this clinical syndrome.

Areas covered: This article gives an overview of the clinical spectrum of constrictive pericardial diseases and the role of multimodality imaging in the diagnosis of constrictive pericarditis. There is a focus on the emerging role of cardiac magnetic resonance (CMR) for the diagnosis, management, and prognostication of patients with constrictive pericarditis based on more recent case series, retrospective and prospective studies, which have helped to define the role of CMR.

Expert opinion: Advanced multimodality imaging assists with identification of both overt and subclinical pericardial inflammation. This allows the pericardiologist to recognize patients with potentially reversible disease, trial medical therapy, and thereby avoid mechanical removal of the pericardium. Further, pericardial characterization by CMR has provided novel information about the natural history of these pericardial conditions, which can help tailor therapy and improve prognosis.     

Turning the old school on its head: stenting as the therapy of choice for SVC syndrome.

A 38-year-old man with a history of migraine headaches with aura and one episode of ischemic stroke was found to have a patent foramen ovale (PFO). After percutaneous closure with the nickel-containing Amplatzer PFO occluder, the patient developed pericarditis, atrial fibrillation, and increased migraine headaches with aura that abated with oral prednisone. He tested positive for nickel hypersensitivity, which we conclude is the likely etiology of his pericarditis.     

Outcome after thrombolytic therapy of nine cases of myopericarditis misdiagnosed as myocardial infarction

Anecdotal reports have suggested that cardiovascular complicationsmay occur if thrombolytic therapy is performed in cases of pericarditismisdiagnosed as acute myocardial infarction. From 1980 to 1993,47 cases of myopericarditis mimicking myocardial infarctionhave been admitted to our institution. The misdiagnosis wasmade because of clinical onset characterized by a typical chestpain, and/or localized ST segment elevation. Since 1987, nine(919 males, age 40±14 years) out of the 47 patients (19%)have been treated with a thrombolytic agent (streptokinase 419,rt-PA 519) followed by intravenous heparin. This treatment wasstarted during the pre-hospital pliase (2/9) and while in hospital(7/9). No pericardial rub was present; ST segment elevationwas mainly localized in inferior and lateral leads; no Q wavedeveloped; median creatine kinase rise was 268 units (range38 to 1280), and only one patient had a small pericardial effusion.The mean level of fibrinogen after thrombolysis was 1.72 g.l^–1 (range 0.10 to 4.50). In all cases, typical ECG cliangeswere present suggesting pericarditis with a subsequent returnto a normal ECG. No severe cardiac or pericardial complicationor arrhytlxmia occurred; only one patient developed a non-compressiveand resolvable pericardial effusion. Cardiac catheterizations(coronary and left ventricular angiographies) were normal whenperformed (5/9). Long-term follow-up (mean 46±29 months)was favourable without any coronary events. In conclusion, thrombolytictherapy was uncomplicated in our patients with myopericarditissimulating evolving myocardial infarction.     

Pericardiocentesis: Insertion of a Pericardial Catheter

Pericardiocentesis is a lifesaving procedure in cardiac tamponade but is associated with significant and often life threatening complications. A patient is described in whom a catheter was inserted into the pericardium. This provided for prolonged pericardial drainage of purulent fluid and has the potential for decreasing the risk of this procedure.