Author + information
- Received September 30, 2009
- Accepted October 18, 2009
- Published online June 29, 2010.
A 15-year-old boy developed cough, low-grade fever, and extreme lethargy over 4 weeks that was unresponsive to a short course of macrolide antibiotic. Laboratory workup was notable for a negative Epstein-Barr virus early antigens antibody, monoslide test, and normal complete blood count. Six weeks later, mild weight gain, 2/6 systolic ejection murmur at the apex, and abdominal distension with ascites was noted. Chest and abdominal computed tomography revealed pericardial effusion and ascites. C-reactive protein was 0.3 mg/dl (normal range 0 to 1.0 mg/dl), and erythrocyte sedimentation rate was 1 mm/h (normal range 0 to 15 mm/h). Transthoracic echocardiogram (A)revealed an interventricular septal bounce with a small organized pericardial effusion (arrow)and pleural effusion (arrowhead). Cardiac magnetic resonance imaging (B)showed moderate diffuse pericardial delayed hyperenhancement after gadolinium administration (arrows). Empiric treatment for presumptive effusive-constrictive pericarditis was begun with steroids and nonsteroidal anti-inflammatory drug. After symptom recurrence, the patient underwent pericardiectomy, where he was noted to have a thickened and densely adhered pericardial sac. Surgical pathology using Movat stain (C)demonstrated pericardial fibrosis with granulation tissue and organizing fibrinous exudate with mild chronic inflammation without acute inflammatory cells or granulomas. He continues to do well 2 months post-operatively. Ao = aorta; LA = left atrium; LV = left ventricle; RV = right ventricle.
The authors wish to thank Dr. Carmela Tan, Department of Pathology, Cleveland Clinic Foundation for the pericardial histology images.
- Received September 30, 2009.
- Accepted October 18, 2009.
- American College of Cardiology Foundation