A 15-year-old with chest pain: An unexpected etiology
A 15-year-old female with no significant past medical history presented to the emergency department with 1 day of substernal and pleuritic chest pain, chills, cough, and hematuria. She also had swelling of the face and ankles that resolved by presentation. She was found to have elevated troponin and...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2022-01-01
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| Series: | SAGE Open Medical Case Reports |
| Online Access: | https://doi.org/10.1177/2050313X211069026 |
| _version_ | 1798015464308211712 |
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| author | Samantha Loza Brandon Tallman Keith Hanson Shane Rainey |
| author_facet | Samantha Loza Brandon Tallman Keith Hanson Shane Rainey |
| author_sort | Samantha Loza |
| collection | DOAJ |
| description | A 15-year-old female with no significant past medical history presented to the emergency department with 1 day of substernal and pleuritic chest pain, chills, cough, and hematuria. She also had swelling of the face and ankles that resolved by presentation. She was found to have elevated troponin and brain natriuretic peptide during initial workup. Electrocardiogram was normal, but there were significant pleural effusions on chest x-ray. She was strep positive and had blood pressure up to 150/90, prompting admission for cardiac monitoring and cardiology consultation. Blood pressure decreased down to 125/72 without intervention. She was afebrile with unlabored breathing and normal saturations. She was clear to auscultation bilaterally, with no abdominal distension or hepatosplenomegaly, and edema was not evident on exam. There was mild erythema to the bilateral tonsillar pillars. Initial considerations included viral myocarditis, pericarditis, and atypical nephritic syndrome. Workup revealed elevated antistreptolysin antibodies, low C3 complement, negative antineutrophil cytoplasmic antibodies, and negative flu testing. Renal sonography was unremarkable. Cardiology recommended echocardiography, which confirmed pleural effusions but revealed no cardiac abnormalities. Urinalysis revealed hematuria and mild proteinuria. Diagnosis was found to be post-streptococcal glomerulonephritis complicated by fluid overload and left ventricular strain secondary to hypertensive emergency. Post-streptococcal glomerulonephritis is the most common cause of acute glomerulonephritis in children. The mechanism of disease is a proliferation and inflammation of the renal glomeruli secondary to immunologic injury, with deposition of immune complexes, neutrophils, macrophages, and C3 after complement activation. This leads to hematuria, proteinuria, and fluid overload. Edema is present in 65%–90% of patients, progressing to pulmonary involvement in severe cases. Cardiac dysfunction secondary to fluid overload is a potentially fatal outcome in the acute setting. Physicians should consider post-streptococcal glomerulonephritis for patients presenting with hypertension, cardiac/pulmonary pathology, or symptoms of acute heart failure in the context of strep infection. |
| first_indexed | 2024-04-11T15:34:57Z |
| format | Article |
| id | doaj.art-b326c3684b29437cb4042a1950ac6da1 |
| institution | Directory Open Access Journal |
| issn | 2050-313X |
| language | English |
| last_indexed | 2024-04-11T15:34:57Z |
| publishDate | 2022-01-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | SAGE Open Medical Case Reports |
| spelling | doaj.art-b326c3684b29437cb4042a1950ac6da12022-12-22T04:16:02ZengSAGE PublishingSAGE Open Medical Case Reports2050-313X2022-01-011010.1177/2050313X211069026A 15-year-old with chest pain: An unexpected etiologySamantha Loza0Brandon Tallman1Keith Hanson2Shane Rainey3The University of Illinois College of Medicine at Peoria, Peoria, IL, USAThe University of Illinois College of Medicine at Peoria, Peoria, IL, USAThe University of Illinois College of Medicine at Peoria, Peoria, IL, USAThe University of Arizona College of Medicine Phoenix, Phoenix, AZ, USAA 15-year-old female with no significant past medical history presented to the emergency department with 1 day of substernal and pleuritic chest pain, chills, cough, and hematuria. She also had swelling of the face and ankles that resolved by presentation. She was found to have elevated troponin and brain natriuretic peptide during initial workup. Electrocardiogram was normal, but there were significant pleural effusions on chest x-ray. She was strep positive and had blood pressure up to 150/90, prompting admission for cardiac monitoring and cardiology consultation. Blood pressure decreased down to 125/72 without intervention. She was afebrile with unlabored breathing and normal saturations. She was clear to auscultation bilaterally, with no abdominal distension or hepatosplenomegaly, and edema was not evident on exam. There was mild erythema to the bilateral tonsillar pillars. Initial considerations included viral myocarditis, pericarditis, and atypical nephritic syndrome. Workup revealed elevated antistreptolysin antibodies, low C3 complement, negative antineutrophil cytoplasmic antibodies, and negative flu testing. Renal sonography was unremarkable. Cardiology recommended echocardiography, which confirmed pleural effusions but revealed no cardiac abnormalities. Urinalysis revealed hematuria and mild proteinuria. Diagnosis was found to be post-streptococcal glomerulonephritis complicated by fluid overload and left ventricular strain secondary to hypertensive emergency. Post-streptococcal glomerulonephritis is the most common cause of acute glomerulonephritis in children. The mechanism of disease is a proliferation and inflammation of the renal glomeruli secondary to immunologic injury, with deposition of immune complexes, neutrophils, macrophages, and C3 after complement activation. This leads to hematuria, proteinuria, and fluid overload. Edema is present in 65%–90% of patients, progressing to pulmonary involvement in severe cases. Cardiac dysfunction secondary to fluid overload is a potentially fatal outcome in the acute setting. Physicians should consider post-streptococcal glomerulonephritis for patients presenting with hypertension, cardiac/pulmonary pathology, or symptoms of acute heart failure in the context of strep infection.https://doi.org/10.1177/2050313X211069026 |
| spellingShingle | Samantha Loza Brandon Tallman Keith Hanson Shane Rainey A 15-year-old with chest pain: An unexpected etiology SAGE Open Medical Case Reports |
| title | A 15-year-old with chest pain: An unexpected etiology |
| title_full | A 15-year-old with chest pain: An unexpected etiology |
| title_fullStr | A 15-year-old with chest pain: An unexpected etiology |
| title_full_unstemmed | A 15-year-old with chest pain: An unexpected etiology |
| title_short | A 15-year-old with chest pain: An unexpected etiology |
| title_sort | 15 year old with chest pain an unexpected etiology |
| url | https://doi.org/10.1177/2050313X211069026 |
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