Transient constrictive pericarditis following coxsackievirus A4 infection as a rare cause of acute mediastinitis: A case report
Background: Transient constrictive pericarditis (TCP) is a distinct constrictive pericarditis (CP) subtype characterized by acute pericardial inflammation and transient constrictive physiology. If left untreated, it may progress to irreversible CP requiring pericardiectomy. However, making an early...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-09-01
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| Series: | Heliyon |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405844023067634 |
| _version_ | 1797669844762492928 |
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| author | Hiroyuki Yamamoto Jun Isogai |
| author_facet | Hiroyuki Yamamoto Jun Isogai |
| author_sort | Hiroyuki Yamamoto |
| collection | DOAJ |
| description | Background: Transient constrictive pericarditis (TCP) is a distinct constrictive pericarditis (CP) subtype characterized by acute pericardial inflammation and transient constrictive physiology. If left untreated, it may progress to irreversible CP requiring pericardiectomy. However, making an early diagnosis of TCP remains difficult. Case presentation: A 51-year-old man presented with fever, chest pain, and dyspnea following preceding flu symptoms. An initial investigation suggested right-sided heart failure. Laboratory results revealed elevated inflammatory markers and hepatic enzyme levels. Echocardiography revealed pericardial effusion with a normal ejection fraction and diastolic ventricular septal bounce suggestive of pericardial constriction. Computed tomography suggested acute descending mediastinitis with pericarditis and pleuritis; however, detailed examinations ruled out this possibility. The constellation of increased serological inflammation, pericardial thickness/effusion, and constrictive physiology suggested TCP, confirmed by cardiac magnetic resonance (CMR) and hemodynamic studies. CMR also revealed coexistent myocarditis. After a thorough assessment for the cause of TCP, a viral etiology was suspected. Paired serology for virus antibody titers revealed a significant increase only in coxsackievirus A4 (CVA4) titers. With prompt anti-inflammatory treatment, the patient’s pericardial structure and function and concomitant inflammation of the surrounding tissues were nearly completely recovered, leading to a final diagnosis of TCP caused by CVA4. The subsequent clinical course was uneventful without recurrence at the 1-year follow-up. Conclusions: Here we described the first case of TCP caused by CVA4 concurrent with mediastinitis, myocarditis, and pleuritis, all of which were successfully resolved with anti-inflammatory treatment. Acute mediastinitis secondary to TCP is rare. This case highlights the clinical importance of assessing pericardial diseases as a source of acute mediastinitis and considering CVA4 as an etiology of TCP. An evaluation including multimodal cardiac imaging and serology for virus antibody titers may be useful for an exploratory diagnosis of TCP in right-sided heart failure patients with pericardial effusion. |
| first_indexed | 2024-03-11T20:50:42Z |
| format | Article |
| id | doaj.art-7f80e807d7d44f5d82b7e3ab563d0563 |
| institution | Directory Open Access Journal |
| issn | 2405-8440 |
| language | English |
| last_indexed | 2024-03-11T20:50:42Z |
| publishDate | 2023-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Heliyon |
| spelling | doaj.art-7f80e807d7d44f5d82b7e3ab563d05632023-10-01T06:00:06ZengElsevierHeliyon2405-84402023-09-0199e19555Transient constrictive pericarditis following coxsackievirus A4 infection as a rare cause of acute mediastinitis: A case reportHiroyuki Yamamoto0Jun Isogai1Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, Chiba, Japan; Corresponding author. Department of Cardiovascular Medicine Narita-Tomisato Tokushukai Hospital 1-1-1 Hiyoshidai, Tomisato, Chiba Japan.Division of Radiology, Asahi General Hospital, Asahi, JapanBackground: Transient constrictive pericarditis (TCP) is a distinct constrictive pericarditis (CP) subtype characterized by acute pericardial inflammation and transient constrictive physiology. If left untreated, it may progress to irreversible CP requiring pericardiectomy. However, making an early diagnosis of TCP remains difficult. Case presentation: A 51-year-old man presented with fever, chest pain, and dyspnea following preceding flu symptoms. An initial investigation suggested right-sided heart failure. Laboratory results revealed elevated inflammatory markers and hepatic enzyme levels. Echocardiography revealed pericardial effusion with a normal ejection fraction and diastolic ventricular septal bounce suggestive of pericardial constriction. Computed tomography suggested acute descending mediastinitis with pericarditis and pleuritis; however, detailed examinations ruled out this possibility. The constellation of increased serological inflammation, pericardial thickness/effusion, and constrictive physiology suggested TCP, confirmed by cardiac magnetic resonance (CMR) and hemodynamic studies. CMR also revealed coexistent myocarditis. After a thorough assessment for the cause of TCP, a viral etiology was suspected. Paired serology for virus antibody titers revealed a significant increase only in coxsackievirus A4 (CVA4) titers. With prompt anti-inflammatory treatment, the patient’s pericardial structure and function and concomitant inflammation of the surrounding tissues were nearly completely recovered, leading to a final diagnosis of TCP caused by CVA4. The subsequent clinical course was uneventful without recurrence at the 1-year follow-up. Conclusions: Here we described the first case of TCP caused by CVA4 concurrent with mediastinitis, myocarditis, and pleuritis, all of which were successfully resolved with anti-inflammatory treatment. Acute mediastinitis secondary to TCP is rare. This case highlights the clinical importance of assessing pericardial diseases as a source of acute mediastinitis and considering CVA4 as an etiology of TCP. An evaluation including multimodal cardiac imaging and serology for virus antibody titers may be useful for an exploratory diagnosis of TCP in right-sided heart failure patients with pericardial effusion.http://www.sciencedirect.com/science/article/pii/S2405844023067634Transient constrictive pericarditisAcute mediastinitisCoxsackievirus A4Constrictive physiologyCardiac magnetic resonanceAnti-inflammatory treatment |
| spellingShingle | Hiroyuki Yamamoto Jun Isogai Transient constrictive pericarditis following coxsackievirus A4 infection as a rare cause of acute mediastinitis: A case report Heliyon Transient constrictive pericarditis Acute mediastinitis Coxsackievirus A4 Constrictive physiology Cardiac magnetic resonance Anti-inflammatory treatment |
| title | Transient constrictive pericarditis following coxsackievirus A4 infection as a rare cause of acute mediastinitis: A case report |
| title_full | Transient constrictive pericarditis following coxsackievirus A4 infection as a rare cause of acute mediastinitis: A case report |
| title_fullStr | Transient constrictive pericarditis following coxsackievirus A4 infection as a rare cause of acute mediastinitis: A case report |
| title_full_unstemmed | Transient constrictive pericarditis following coxsackievirus A4 infection as a rare cause of acute mediastinitis: A case report |
| title_short | Transient constrictive pericarditis following coxsackievirus A4 infection as a rare cause of acute mediastinitis: A case report |
| title_sort | transient constrictive pericarditis following coxsackievirus a4 infection as a rare cause of acute mediastinitis a case report |
| topic | Transient constrictive pericarditis Acute mediastinitis Coxsackievirus A4 Constrictive physiology Cardiac magnetic resonance Anti-inflammatory treatment |
| url | http://www.sciencedirect.com/science/article/pii/S2405844023067634 |
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