Clinical microbiological case: cardiac tamponade due to hemorrhagic pericarditis in a non-immunocompromised woman from south-eastern United States

Abstract

Four days after the initial pericardiocentesis, the patient underwent localized pericardectomy due to re-accumulation of pericardial fluid. (Figure 1) Full-thickness pericardial biopsy was also performed. Negative serology included: human immunodeficiency virus types I and II, human T-cell leukemia virus types I and II, cytomegalovirus immunoglobulin M (CMV IgM), Venereal Disease Research Laboratory (VDRL), antinuclear antibody, native DNA antibody, Smith (SM) antibody, and ribonucleoprotein (RNP) antibody. Her complement (CH50, C3, C4) levels were normal. Serum rheumatoid factor and urine Histoplasma capsulatum antigen were nondetectable. Blood cultures for bacteria, mycobacteria and viruses remained sterile for 21 days. Histopathological examination of the pericardial biopsy showed organizing hemorrhage and prominent lymphocytic infiltration of the stroma. (Figure 2a) Intranuclear and intracytoplasmic inclusions within the reactive fibroblasts showed an ‘Owl’s eye’ pattern, characteristic of active CMV infection [1–3] (Figure 2b). CMV-specific IgG serum levels were 102 IU. A 28-day treatment with ganciclovir (5mg/kg body weight every 12 h) was commenced, and a maintenance dose (5mg/kg body weight daily) was given during the last 2 weeks. After discontinuation of antiviral therapy, no clinical relapses were noticed during the 12-month follow-up.