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- Received June 15, 2010
- Accepted June 24, 2010
- Published online June 14, 2011.
A 25-year-old woman presented with sepsis syndrome and diffuse purpuric rash (A). The electrocardiogram showed diffuse ST-segment elevation (B). Cardiac troponin-I and creatine kinase-myocardial band levels were markedly elevated. The echocardiogram demonstrated global left ventricular (LV) hypokinesis (Online Video 1). Three days later, the patient became tachycardic and hypotensive. Repeat echocardiogram showed large circumferential pericardial effusion (PE), right atrial (RA) systolic inversion, impaired right ventricular (RV) relaxation, and marked respirophasic variation (>25%) in the mitral inflow velocities consistent with cardiac tamponade (C [yellow arrow] and D, Online Video 2). Emergent pericardiocentesis yielded 650 ml of exudative fluid. Skin biopsy demonstrated small-vessel vasculitis (E). The initial Rocky Mountain spotted fever (RMSF) immunoglobulin M antibody titer was negative. Eight days later, a second RMSF immunoglobulin M titer was markedly elevated, a finding diagnostic of acute RMSF infection. LA = left atria.
- Received June 15, 2010.
- Accepted June 24, 2010.
- American College of Cardiology Foundation