SESSION TITLE: Fellows Chest Infections Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Fibrosing mediastinitis (FM) is a rare fibroinflammatory disease classified as idiopathic or secondary. Most common infectious cause in the United states is histoplasma. Additional causes include malignancy, autoimmune, and sarcoidosis. CASE PRESENTATION: 45-year-old female presented with chest pain. A transthoracic echocardiogram (TTE) showed pericardial effusion with tamponade physiology and pericardial window with biopsy was done. Pathology showed fibrovascular tissue, adipose tissue with perivascular chronic inflammation. Cytology; negative for malignancy. Weakly positive Coxsackie titers were 1:16 and 1:8 for B1 & B2 respectively, negative bacterial, fungal, mycobacterial, and viral cultures. Negative Lyme antibody titers, mycoplasma IgG, cryptococcal and histoplasma antigens. Normal IgG levels. Negative rheumatological work up apart from weakly positive anti-nuclear antibody. Progressive symptoms of dyspnea despite treatment with anti-inflammatory medications. Subsequent CT showed mediastinal mass encasing the right pulmonary artery (PA) trunk (figure 1). Moderate to severe narrowing of the right PA seen on cardiac MRI. Bronchoscopy with EBUS guided TBNA revealed lymphocytes but no definite diagnosis. Endovascular biopsy of the mediastinal mass showed fibrillar sclerosing lesion with plasma cells and necrotizing granuloma. IgG staining positive for IgG4+ plasma cells but not enough to meet criteria for IgG4-related disease. Abundance of CD20+ve cells on histology. DISCUSSION: Patient did not meet criteria for IgG4-RD diagnosis. She tested negative for all secondary etiologies. Coxsackie virus infection causing chronic pericarditis leading to FM is our hypothesis. CONCLUSIONS: This represents the first report of FM caused by chronic pericarditis probably due to coxsackie viral infection. Reference #1: RadioGraphics 2019; 39:651-667 Reference #2: Ann Thorac Med. 12(3):209-212 DISCLOSURES: No relevant relationships by Sammar Alsunaid, source=Web Response no disclosure on file for Allen Burke; no disclosure on file for Joseph Friedberg; No relevant relationships by Van Holden, source=Web Response Consultant relationship with Medtronic Please note: $1001 - $5000 Added 06/11/2020 by Edward Pickering, source=Web Response, value=Consulting fee Consultant relationship with Merit Endotek Please note: $1-$1000 Added 04/06/2020 by Ashutosh Sachdeva, source=Web Response, value=Consulting fee Consultant relationship with Medtronic Please note: $1001 - $5000 Added 04/06/2020 by Ashutosh Sachdeva, source=Web Response, value=Consulting fee Speaker/Speaker's Bureau relationship with COOK Please note: $1001 - $5000 Added 04/06/2020 by Ashutosh Sachdeva, source=Web Response, value=Honoraria Consultant relationship with Medtronic Please note: $1001 - $5000 by Ashutosh Sachdeva, source=Web Response, value=Consulting fee Unrestricted education grant relationship with Olympus Please note: $1001 - $5000 by Ashutosh Sachdeva, source=Web Response, value=Grant/Research Support Consultant relationship with COOK Please note: $1001 - $5000 Added 04/27/2020 by Ashutosh Sachdeva, source=Web Response, value=Honoraria
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