Abstract
A 67-year-old Caucasian woman was admitted because of severe dyspnea at rest, left-sided pleuritic chest pain, septic fever (up to 39 °C), generalized lymphadenopathy, and a pericardial effusion, without signs of cardiac tamponade. She had a 5-year history of ischemic heart disease, hypertension and hypercholesterolemia. Three months before the current admission, the patient was hospitalized in our department because of suspectedmyocarditiswith the ejection fraction (LVEF) 35%. However, inflammatory markers were normal: CRP 2.3 mg/L (normal: b3.0 mg/L), fibrinogen 3.2 g/L (normal: b3.5 g/L), leukocytes 5.3×10/L, erythrocyte sedimentation rate 14 mm/h. Serum troponin I (cTnI) was negative. Serologic studies for enteroviruses, influenza and parainfluenza viruses, cytomegalovirus and Epstein–Barr virus were all negative. TSHwas normal and an autoimmune screen was negative. Cardiac catheterization showed no significant (b50%) coronary artery lesions. Takotsubo cardiomyopathy was excluded. On the current admission, her body temperature was 37.2 °C, HR 80/min, respiratory rate 20/min, blood pressure 120/80 mm Hg, and oxygen saturation 96%. Electrocardiography revealed sinus rhythm, low voltage in limb leads, and previously present left bundle branch block. A chest X-ray showed bilateral pleural effusions and an enlarged cardiac silhouette (Fig. 1). Echocardiography disclosed severe
Published Version
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