Absceso en miocardio secundario a neumonía adquirida en la comunidad por Pseudomona aeruginosa en lactante inmunocompetente: reporte de caso / Myocardial abscess secondary to community acquired Pseudomona aeruginosa pneumonia in an immunocompetent infant: case report

La Pseudomona aeruginosa es una causa importante de infecciones asociadas a la atención de la salud y en las neumonías adquiridas en la comunidad, rara vez se identifica como el agente patógeno, siendo estas de progresión rápida y de mal pronóstico. Se trata de un menor de un año de edad inmunocompetente el cual fallece en casa una semana después de una lesión en la planta del pie derecho que según familiares le sacaron "pus", tratado con antinflamatorios y analgésicos. Se le realizó necropsia que evidenció cicatriz en planta de pie derecho sin lesiones traumáticas. Pulmones de consistencia indurada, con adherencias y áreas que impresionan necróticas, asociada a efusión pleural. El estudio histológico reportó un proceso infeccioso pulmonar agudo abscedado que se diseminó por continuidad a tejido cardiaco y en estudios microbiológicos de pulmón y bazo se reportó Pseudomona aeruginosa.

Pseudomona aeruginosa is an important cause of health care-associated infections and in community-acquired pneumonias, it is rarely identified as the pathogenic agent, being of rapid progression and poor prognosis. This is a one-year-old immunocompetent minor who died at home one week after a lesion in the sole of the right foot which, according to family members, caused "pus", treated with anti-inflammatory and analgesic drugs. A necropsy was performed, which showed a scar on the sole of the right foot with no traumatic lesions. Lungs of indurated consistency, with adhesions and areas that appear necrotic, associated with pleural effusion. The histological study reported an abscessed acute pulmonary infectious process that spread by continuity to cardiac tissue and microbiological studies of lung and spleen reported Pseudomona aeruginosa.

Signo de Spodick: ¿aliado o enemigo? / Spodick's sign: ally or enemy?

La pericarditis se refiere a la inflamación de las capas del pericardio y es la forma más común de enfermedad pericárdica. Puede estar asociada a derrame pericárdico y resultar en un taponamiento. La enfermedad puede ser una condición aislada o una manifestación cardíaca de un trastorno sistémico (por ejemplo, enfermedades autoinmunes o autoinflamatorias). La pericarditis se categoriza como aguda, incesante, recurrente o crónica, pero se debe tener en cuenta que también se clasifica como de etiología infecciosa y no infecciosa, siendo la presentación idiopática la más común

Pericarditis refers to inflammation of the layers of the pericardium and is the most common form of pericardial disease. It may be associated with pericardial effusion and result in tamponade. The disease may be an isolated condition or a cardiac manifestation of a systemic disorder (e.g., autoimmune or autoinflammatory diseases). Pericarditis is categorized as acute, incessant, recurrent, or chronic, but it should be noted that it is also classified as being of infectious and noninfectious etiology, with the idiopathic presentation being the most common

Utilidad de la tomografía computarizada multicorte para la estimación de la composición del derrame pericárdico / Usefulness of computed tomography densities to estimate the composition of pericardial effusion

Resumen El derrame pericárdico (DP) es una entidad frecuente en la práctica diaria, que puede ocurrir por un amplio rango de patologías. Los métodos por imágenes constituyen una herramienta diagnóstica clave en la evaluación del pericardio. El ecocardiograma transtorácico (ETT) se considera de primera línea por su costo-efectividad. La tomografía computarizada multicorte (TCMC), por su parte, representa un valioso complemento ante limitaciones del ETT y en la evaluación de urgencia del paciente con sospecha de DP. El objetivo del trabajo es mostrar la utilidad y rol de la TCMC, mediante la medición de densidades, para estimar la etiología del DP, ilustrado con casos de nuestra institución.

Abstract Pericardial effusion (PE) is a common entity in daily practice, which can occur due to a wide range of conditions. Imaging methods are a key diagnostic tool in the evaluation of the pericardium. Transthoracic echocardiogram (TTE) is the first line imaging method because of its cost-effectiveness. Multi-slice Computed Tomography (MSCT), on the other hand, represents a valuable complement to the limitations of TTE and in emergency evaluation of the patient with suspected PE. The objective of this review is to show the usefulness and role of the MSCT —through the measurement of densities— to estimate the etiology of PE, illustrated with cases of our Institution.

Manifestations cardiovasculaires au cours de l'infection à VIH à Libreville: étude comparative de patients séropositifs et séronégatifs / Cardiovascular Manifestations during HIV infection in Libreville: Comparative study of seropositive and seronegative patients

Introduction. Le spectre des atteintes cardiovasculaires au cours de l'infection à VIH a été modifi é par la trithérapie antirétrovirale. L'objectif de ce travail était de décrire le profi l des manifestations cardiovasculaires chez les patients vivants avec le VIH en le comparant à celui de patients séronégatifs. Méthodes. Il s'est agi d'une étude cas-témoins des dossiers de patients respectivement séropositifs et séronégatifs hospitalisés pour une pathologie cardiovasculaire au service de cardiologie du Centre Hospitalier Universitaire de Libreville de janvier 2015 à décembre 2018. L'analyse statistique a été réalisée à l'aide du logiciel Statview 5.0. Lestests de Chi-2 de Pearson ou Exact de Ficher ont été utilisés pour la comparaison des proportions. Résultats. L'étude a porté sur sur l'analyse de 82 et 150 dossiers de patients respectivement séropositifs et séronégatifs. Un âge inférieur à 50 ans était retrouvé chez 70,7% des séropositifs et 43,3% des séronégatifs (p<0,01). Le taux de CD4 moyen des séropositifs était de 189±170/mm3 et 45,1% d'entre eux étaient sous trithérapie antiretrovirale.La cardiomyopathie dilatée était l'atteinte cardiaque la plus fréquente chez les séropositifs (42,7%) et chez les séronégatifs (52,7%) (p=0,14). La maladie thromboembolique veineuse était relevée chez 7(8,5%) séropositifs et 14 (8,8%) séronégatifs (p=0,93). Une péricardite était diagnostiquée chez 25,6% des séropositifs avec une étiologie tuberculeuse dans 85,7% des cas. Les pathologies vasculaires athéromateuses étaient plus fréquentes chez les séronégatifs (23,1%) comparés aux séropositifs (6,1%) (p<0,01). La mortalité des séropositifs était principalement due aux péricardites (71,4%). Conclusion. les manifestations cardiovasculaires liées à l'immunodépression persistent chez les personnes vivant avec le VIH à Libreville. Un dépistage précoce de ces atteintes permettrait de réduire la mortalité.

Introduction. The spectrum of cardiovascular damage during HIV infection has been modified by triple antiretroviral therapy. The objective of this study was to describe the profile of cardiovascular manifestations in patients living with HIV by comparing it to the one of seronegative patients. Methods. This was a case-control study which focused on the files of patients hospitalized for a cardiovascular pathology in the cardiology department of the Center Hospitalier Universitaire de Libreville from january 2015 to december. 2018. Results. In total, there was on the analysis of the files of 82 seropositive patients and 150 seronegative patients. The age found was less than 50 years old in 70.7% of seropositives and 43.3% of seronegatives (p <0.01). The mean CD4 count in seropositives was 189 ± 170 /mm3 and 45.1% of them were on triple antiretroviral therapy. Dilated cardiomyopathy was the most common cardiac disease in HIVpositive (42.7%) and HIV-negative (52.7%) (p = 0.14). Venous thromboembolic disease was noted in 7 (8.5%) seropositives and 14 (8.8%) seronegatives (p=0.93).Pericarditis was diagnosed in 25.6% of seropositives patients with a tuberculous etiology in 85.7% of cases. Atheromatous vascular pathologies were more frequent in seronegative (23.1%) compared to seropositive (6.1%) (p <0.01). Mortality among seropositive was mainly due to pericarditis (71.4%)

Oral administration of TRPV4 inhibitor improves atrial calcium handling abnormalities in sterile pericarditis rats / 生理学报

Atrial Ca2+ handling abnormalities, mainly involving the dysfunction of ryanodine receptor (RyR) and sarcoplasmic reticulum Ca2+-ATPase (SERCA), play a role in the pathogenesis of atrial fibrillation (AF). Previously, we found that the expression and function of transient receptor potential vanilloid subtype 4 (TRPV4) are upregulated in a sterile pericarditis (SP) rat model of AF, and oral administration of TRPV4 inhibitor GSK2193874 alleviates AF in this animal model. The aim of this study was to investigate whether oral administration of GSK2193874 could alleviate atrial Ca2+ handling abnormalities in SP rats. A SP rat model of AF was established by daubing sterile talcum powder on both atria of Sprague-Dawley (SD) rats after a pericardiotomy, to simulate the pathogenesis of postoperative atrial fibrillation (POAF). On the 3rd postoperative day, Ca2+ signals of atria were collected in isolated perfused hearts by optical mapping. Ca2+ transient duration (CaD), alternan, and the recovery properties of Ca2+ transient (CaT) were quantified and analyzed. GSK2193874 treatment reversed the abnormal prolongation of time to peak (determined mainly by RyR activity) and CaD (determined mainly by SERCA activity), as well as the regional heterogeneity of CaD in SP rats. Furthermore, GSK2193874 treatment relieved alternan in SP rats, and reduced its incidence of discordant alternan (DIS-ALT). More importantly, GSK2193874 treatment prevented the reduction of the S2/S1 CaT ratio (determined mainly by RyR refractoriness) in SP rats, and decreased its regional heterogeneity. Taken together, oral administration of TRPV4 inhibitor alleviates Ca2+ handling abnormalities in SP rats primarily by blocking the TRPV4-Ca2+-RyR pathway, and thus exerts therapeutic effect on POAF.

Pericarditis and myocarditis after COVID-19 mRNA vaccination in a nationwide setting

INTRODUCTION@#Despite reports suggesting an association between COVID-19 mRNA vaccination and pericarditis and myocarditis, detailed nationwide population-based data are sparsely available. We describe the incidence of pericarditis and myocarditis by age categories and sex after COVID-19 mRNA vaccination from a nationwide mass vaccination programme in Singapore.@*METHODS@#The incidence of adjudicated cases of pericarditis and myocarditis following COVID-19 mRNA vaccination that were reported to the vaccine safety committee between January to July 2021 was compared with the background incidence of myocarditis in Singapore.@*RESULTS@#As of end July 2021, a total of 34 cases were reported (9 pericarditis only, 14 myocarditis only, and 11 concomitant pericarditis and myocarditis) with 7,183,889 doses of COVID-19 mRNA vaccine administered. Of the 9 cases of pericarditis only, all were male except one. The highest incidence of pericarditis was in males aged 12-19 years with an incidence of 1.11 cases per 100,000 doses. Of the 25 cases of myocarditis, 80% (20 cases) were male and the median age was 23 years (range 12-55 years) with 16 cases after the second dose. A higher-than-expected number of cases were seen in males aged 12-19 and 20-29 years, with incidence rates of 3.72 and 0.98 case per 100,000 doses, respectively.@*CONCLUSION@#Data from the national registry in Singapore indicate an increased incidence of pericarditis and myocarditis in younger men after COVID-19 mRNA vaccination.

Pericardial Effusion and Cardiac Tamponade: Etiology and Evolution in the Contemporary Era

Abstract Background: Pericardial effusion is a relatively common finding and can progress to cardiac tamponade; etiological diagnosis is important for guiding treatment decisions. With advances in medicine and improvement in the social context, the most frequent etiological causes have changed. Objectives: To evaluate the clinical and laboratory characteristics, etiology, and clinical course of patients with pericardial effusion and cardiac tamponade. Materials and methods: Patients with pericardial effusion classified as small (< 10 mm), moderate (between 10-20 mm), or severe (> 20 mm) were included. Data from the clinical history, physical examination, laboratory tests, and complementary tests were evaluated in patients with pericardial effusion and cardiac tamponade. The significance level was set at 5%. Results: A total of 254 patients with a mean age of 53.09 ± 17.9 years were evaluated, 51.2% of whom were female. A total of 40.4% had significant pericardial effusion (> 20 mm). Pericardial tamponade occurred in 44.1% of patients. Among pericardial effusion patients without tamponade, the most frequent etiologies were: idiopathic (44.4%) and postsurgical (17.6%), while among those with tamponade, the most frequent etiologies were postsurgical (21.4%) and postprocedural (19.6%). The mean follow-up time was 2.2 years. Mortality was 42% and 23.2 in those with and without tamponade, respectively (p=0.001). Conclusions: There is an etiological difference between pericardial effusion patients with and without cardiac tamponade. An idiopathic etiology is more common among those without tamponade, while postinterventional/postsurgical is more common among those with tamponade. The tamponade group had a higher mortality rate.

Predictive factors of recurrence after pediatric acute pericarditis

Abstract Objective The predisposing factors for pericarditis recurrence in the pediatric population have not yet been established. This study aimed to define the risk factors for the unfavorable prognosis of pediatric acute pericarditis. Methods This was a retrospective study that included all patients with acute pericarditis treated from 2011 to 2019 at a tertiary referent pediatric center. Results The study included 72 children. Recurrence was observed in 22.2% patients. Independent risk factors for recurrence were: erythrocyte sedimentation rate ≥ 50 mm/h (p = 0.003, OR 186.3), absence of myocarditis (p = 0.05, OR 15.2), C-reactive protein ≥ 125 mg/L (p = 0.04, OR 1.5), and non-idiopathic etiology pericarditis (p = 0.003, OR 1.3). Corticosteroid treatment in acute pericarditis was associated with a higher recurrence rate than treatment with non-steroid anti-inflammatory therapy (p = 0.04). Furthermore, patients treated with colchicine in the primary recurrence had lower recurrence rate and median number of repeated infections than those treated without colchicine (p = 0.04; p = 0.007, respectively). Conclusion Independent risk factors for recurrence are absence of myocarditis, non-idiopathic etiology pericarditis, C-reactive protein ≥ 125 mg/L, and erythrocyte sedimentation rate ≥ 50 mm/h. Acute pericarditis should be treated with non-steroid anti-inflammatory therapy. A combination of colchicine and non-steroid anti-inflammatory drugs could be recommended as the treatment of choice in recurrent pericarditis.

Miopericarditis aguda versus síndrome coronario agudo: reporte de un caso / Acute myopericarditis versus acute coronary syndrome: case report / Miopericardite aguda versus síndrome coronariana aguda: relato de um caso

La miopericarditis aguda es una pericarditis aguda con compromiso miocárdico menor. En las primeras horas de evolución el cuadro clínico puede confundirse con un síndrome coronario agudo, en especial cuando el electrocardiograma presenta elevación del segmento ST y marcadores de necrosis miocárdica elevados. La resonancia magnética cardíaca tiene un papel importante para diferenciar las dos enfermedades. Presentamos el caso de un hombre de 36 años de edad ingresado por dolor de pecho, elevación del segmento ST y de marcadores de necrosis miocárdica. Se realiza angiografía coronaria, que no evidencia lesiones angiográficamente significativas, resonancia magnética cardíaca con contraste de gadolinio, en la que se observa leve derrame pericárdico, presencia de edema y realce tardío con patrón parcheado subepicárdico e intramiocárdico en pared lateral. Los hallazgos del estudio confirman el diagnóstico de miopericarditis.

Acute myopericarditis is an acute pericarditis with minor myocardial compromise. During the first hours from onset the clinical presentation can be confused with an acute coronary syndrome, especially when the electrocardiogram presents with ST segment elevation and increased markers of myocardial necrosis. Cardiac magnetic resonance imaging plays an important role to differentiate between these two diseases. We present the case of a 36-year-old male who was admitted with chest pain, ST segment elevation and increased markers of myocardial necrosis. Coronary angiography is performed reporting no significant angiographic findings. Cardiac magnetic resonance imaging with contrast medium (gadolinium) is performed, reporting mild pericardial effusion, presence of edema, and delayed uptake with a subepicardial and intramyocardial patchy pattern on the lateral wall. These test findings confirm the diagnosis of myopericarditis.

A miopericardite aguda é uma pericardite aguda com pequena deterioração miocárdica. Nas primeiras horas de evolução do quadro clínico podem ser confundidas com síndrome coronariana aguda, principalmente quando o eletrocardiograma mostra supradesnivelamento do segmento ST e marcadores elevados de necrose miocárdica. A ressonância magnética cardíaca desempenha um papel importante em distinguir as duas doenças. Apresentamos o caso de um homem de 36 anos admitido por dor torácica, supradesnivelamento do segmento ST e elevação dos marcadores de necrose miocárdica, foi realizada cineangiocoronariografia, onde não foram evidenciadas lesões angiograficamente significativas. Foi realizada a ressonância magnética cardíaca com contraste de gadolínio e foram observados derrame pericárdico leve, edema e realce tardio com um padrão irregular subepicárdico e intramiocárdico na face lateral. Os resultados do estudo confirmam o diagnóstico de miopericardite.

Síndrome de Brugada asociado a pericarditis aguda / Brugada syndrome associated to acute pericarditis

Resumen Comunicamos el caso de un hombre de 56 años que ingresó por pericarditis aguda febril, probablemente de causa viral, que durante su evolución presentó una fibrilación auricular paroxística y taquicardia ventricular polimorfa recurrente. El análisis de la historia clínica y serie electrocardiográfica permitió el diagnóstico retrospectivo asociado de un síndrome de Brugada. Hubo buena respuesta inicial al tratamiento antiinflamatorio asociado a colchicina y se implantó un desfibrilador automático intracavitario para prevención de muerte súbita. Se discuten aspectos clínicos del síndrome de Brugada, la importancia de la fiebre y de la pericarditis como cuadro clínico asociado.

Abstract A 56-year-old patient was admitted for acute febrile pericarditis, probably viral, who presented with paroxysmal atrial fibrillation and recurrent polymorphic ventricular tachycardia during his clinical course. Analysis of the clinical and electrocardiographic findings allowed the retrospective diagnosis of Brugada syndrome in the context of pericarditis. An initial response to anti-inflammatory treatment associated with colchicine was good. An internal cardioverter defibrillator was implanted to prevent sudden death. Clinical aspects of the Brugada syndrome, the importance of fever and pericarditis as an associated clinical condition are discussed.

Tratamiento quirúrgico de la pericarditis purulenta: reporte de un caso / Surgical treatment of purulent pericarditis: report of a case

Resumen Introducción: La pericarditis es la enfermedad del pericardio más presente en la práctica médica. La pericarditis purulenta representa el 5% de ellas, con una mortalidad de hasta el 40%. Caso Clínico: Se presenta un paciente masculino, de 27 años de edad, con antecedentes de hipotiroidismo que ingresa con tos y expectoración amarillenta, asociado a fiebre, que resolvió con tratamiento antibiótico. Un mes después, reingresa con dolor abdominal, astenia y disnea intensa que no tolera el decúbito. Se indica ecocardiograma, que diagnostica derrame pericárdico severo, con colapso de cavidades derechas. Se procedió a pericardiocentesis de emergencia, donde se extrajeron 450 mililitros de líquido purulento. En el seguimiento ecocardiográfico a las 48 h, se observa aumento del derrame, por lo que se decide tratamiento quirúrgico, mediante toracotomía anterolateral izquierda, encontrando derrame purulento y engrosamiento pericárdico de 6 mm, con múltiples adherencias. Se indica pericardiectomía parcial. El paciente evolucionó favorablemente, egresándose 7 días posteriores a la cirugía.

Introduction: Pericarditis is frecuent pericardial disease in medical practice. The purulent pericarditis represents 5%, with a mortality of up to 40%. Case Report: We present a male patient, 27 years old, with a history of hypothyroidism that enters with cough and yellowish expectoration, associated with fever, resolved with antibiotic treatment. One month later, he reenters with abdominal pain, asthenia and intense dyspnea that does not tolerate decubitus. Echocardiogram diagnosed severe pericardial effusion, with collapse of right cavities. Emergency pericardiocentesis was performed and 450 milliliters of purulent fluid were extracted. In the echocardiographic follow-up at 48 hours, an increase in the effusion was observed, was decided surgical treatment by left anterolateral thoracotomy, finding purulent effusion and pericardial thickening of 6 mm, with multiple adhesions. Partial pericardiectomy is indicated. The patient evolved favorably, leaving 7 days after surgery.

Impending Cardiac Tamponade and Hemorrhagic Pleural Effusion as Initial Presentations of Incomplete Kawasaki Disease: A Case Report

Kawasaki disease (KD) is an acute febrile illness that is characterized by systemic inflammation usually involving medium-sized arteries and multiple organs during the acute febrile phase, leading to associated clinical findings. The diagnosis is based on the principal clinical findings including fever, extremity changes, rash, conjunctivitis, oral changes, and cervical lymphadenopathy. However, KD diagnosis is sometimes overlooked or delayed because other systemic organ manifestations may predominate in acute phase of KD. As a cardiovascular manifestation, an acute pericarditis usually shows a small pericardial effusion, but large pericardial effusion showing clinical signs of cardiac tamponade is very rare. Here, we described a case of incomplete KD presenting with impending cardiac tamponade, and recurrent fever and pleural effusion.

Hypertrophic cardiomyopathy masked by pericarditis

Hypertrophic cardiomyopathy used to be regarded as a rare untreatable cause of sudden death in young male athletes. This report is the case of a middle-aged female patient with hereditary hypertrophic cardiomyopathy masked by superimposed pericarditis and revealed by autopsy. This case report illustrates how co-morbidity can hide a crucial diagnosis. This case report also illustrates the value of autopsy disclosing a familial disease that is increasingly recognized and dramatically more treatable than a few decades ago. Sudden death due to hypertrophic cardiomyopathy has become preventable, if the diagnosis is made soon enough. The lessons for patient care from this case include the importance of not missing the diagnosis of hypertrophic cardiomyopathy in female patients.

Treatment of pericardial effusion through subxiphoid tube pericardiostomy and computerized tomography- or echocardiography - guided percutaneous catheter drainage methods

Abstract Objective: In this retrospective study, we aimed to observe the efficacy of pericardial effusion (PE) treatments by a survey conducted at the Department of Cardiovascular Surgery, Faculty of Medicine, Atatürk University. Methods: In order to get comparable results, the patients with PE were divided into three groups - group A, 480 patients who underwent subxiphoid pericardiostomy; group B, 28 patients who underwent computerized tomography (CT)-guided percutaneous catheter drainage; and group C, 45 patients who underwent echocardiography (ECHO)-guided percutaneous catheter drainage. Results: In the three groups of patients, the most important symptom and physical sign were dyspnea and tachycardia, respectively. The most common causes of PE were uremic pericarditis in patients who underwent tube pericardiostomy, postoperative PE in patients who underwent CT-guided percutaneous catheter drainage, and cancer-related PE in patients who underwent ECHO-guided percutaneous catheter drainage. In all the patients, relief of symptoms was achieved after surgical intervention. There was no treatment-related mortality in any group of patients. In patients with tuberculous pericarditis, the rates of recurrent PE and/or constrictive pericarditis progress were 2,9% and 2,2% after tube pericardiostomy and ECHO-guided percutaneous catheter drainage, respectively. Conclusion: Currently, there are many methods to treat PE. The correct treatment method for each patient should be selected according to a very careful analysis of the patient's clinical condition as well as the prospective benefit of surgical intervention.

Diagnóstico diferencial de pericardite aguda no infarto agudo do miocárdio com supradesnivelamento de segmento ST: relato de caso / Differential diagnosis of acute pericarditis in ST-segment elevation acute myocardial infarction: case report

A pericardite é um processo inflamatório do pericárdio de múltiplas causas, sendo a infecção viral a mais comum. O infarto agudo do miocárdio é um dos principais diagnósticos diferenciais. O objetivo deste artigo foi relatar um caso de pericardite aguda com supradesnivelamento de segmento ST. Os dados foram coletados em um hospital de ensino do Estado de Minas Gerais. O paciente era do sexo masculino, tinha 24 anos e era negro. Foi encaminhado ao serviço médico terciário devido à hipótese de síndrome coronariana aguda com supradesnivelamento do segmento ST. Nos exames do serviço médico de origem, apresentava supradesnivelamento do segmento ST de caráter difuso simultaneamente em paredes inferior e anterior, e alteração da isoenzima MB da creatina quinase de 100ng/mL e troponina I de 21ng/mL. No momento da admissão, encontrava-se em bom estado geral, afebril, estável hemodinamicamente e sem queixa de dor. Referiu que 4 dias antes da admissão, apresentou febre, mal-estar geral, odinofagia e tratamento de amigdalite. Os exames da admissão demonstravam ritmo sinusal, frequência cardíaca de 75bpm, supradesnivelamento de ST em D2, D3, aVF, V1 a V6, isoenzima MB da creatina quinase de 152ng/mL, troponina I de 1,28ng/mL, hemograma normal; ecocardiograma mostrou pericárdio de aspecto anatômico normal e fração de ejeção de 64%. O diagnóstico foi de pericardite aguda de provável etiologia infecciosa. O tratamento foi realizado com ibuprofeno por 7 dias e colchicina por 3 meses. Paciente evoluiu com alta hospitalar após 5 dias. O diagnóstico correto proporcionou a condução adequada do caso, permitindo a redução dos custos hospitalares e eliminando riscos de procedimentos desnecessários. (AU)

Pericarditis is an inflammatory process of the pericardium of multiple causes, being the most common viral infection. Acute myocardial infarction is one of the main differential diagnoses. The objective of this article was to report a case of acute pericarditis with ST-segment elevation. Data were collected at a teaching hospital in the state of Minas Gerais. The patient was a man of 24 years, black. He was referred to the tertiary medical service due to the hypothesis of Acute Coronary Syndrome with ST-segment elevation. In the tests from the medical service of origin, there was diffuse ST-segment elevation, simultaneously on lower and anterior walls, and a change in the Creatinine Kinase MB Isoenzyme of 100ng/ml, and troponin I of 21ng/ml. At the time of admission, he was in good general condition, afebrile, hemodynamically stable, with no complaint of pain. He said that 4 days before admission he had fever, malaise, odynophagia, and treatment for tonsillitis. The admission tests showed sinus rhythm, heart rate of 75bpm, ST-elevation in D2, D3, aVF, V1 to V6, MB isoenzyme of creatine kinase of 152ng/ml, troponin I of 1.28ng/ml, normal complete blood count; echocardiogram showed pericardium of normal anatomical aspect and ejection fraction of 64%. The diagnosis was acute pericarditis of probable infectious etiology. Treatment was performed with ibuprofen for seven days, and colchicine for three months. The patient was discharged from hospital after 5 days. The correct diagnosis provided adequate case management, allowing for reduced hospital costs, and eliminating risks of unnecessary procedures. (AU)

Associação de meningite e pericardite na doença pneumocócica invasiva: um caso raro / Association of meningitis and pericarditis in invasive pneumococcal disease: a rare case

RESUMO Objetivo: Relatar um caso raro de uma criança com meningite associada a pericardite na doença pneumocócica invasiva. Descrição do caso: Este relato descreve uma evolução clínica desfavorável de um lactente feminino de 6 meses de idade, previamente hígido, que apresentou inicialmente sintomas respiratórios e febre. A radiografia de tórax revelou um aumento da área cardíaca sem alterações radiográficas nos pulmões. Após a identificação do derrame pericárdico, o paciente apresentou convulsões e entrou em coma. Pneumonia foi descartada durante a investigação clínica. Contudo, foi identificado Streptococcus pneumoniae nas culturas de líquor e sangue. O exame neurológico inicial foi compatível com morte encefálica, posteriormente confirmada pelo protocolo. Comentários: A pericardite purulenta tornou-se uma complicação rara da doença pneumocócica invasiva desde o advento da terapia antibiótica. Pacientes com pneumonia extensa são primariamente predispostos e, mesmo com tratamento adequado e precoce, estão sujeitos a altas taxas de mortalidade. A associação de meningite pneumocócica e pericardite é incomum e, portanto, de difícil diagnóstico. Por isso, uma alta suspeição diagnóstica é necessária para instituir o tratamento precoce e aumentar a sobrevida.

ABSTRACT Objective: To report a rare case of a child with invasive pneumococcal disease that presented meningitis associated with pericarditis. Case description: This report describes the unfavorable clinical course of a previously healthy 6-months-old female infant who initially presented symptoms of fever and respiratory problems. A chest X-ray revealed an increased cardiac area with no radiographic changes in the lungs. After identifying a pericardial effusion, the patient experienced seizures and went into coma. Pneumonia was excluded as a possibility during the clinical investigation. However, Streptococcus pneumoniae was identified in the cerebrospinal fluid and blood cultures. An initial neurological examination showed that the patient was brain dead, which was then later confirmed according to protocol. Comments: Purulent pericarditis has become a rare complication of invasive pneumococcal disease since the advent of antibiotic therapy. Patients with extensive pneumonia are primarily predisposed and, even with early and adequate treatment, are prone to high mortality rates. The association of pneumococcal meningitis and pericarditis is uncommon, and therefore difficult to diagnose. As such, diagnostic suspicion must be high in order to institute early treatment and increase survival.

A pediatric case of eosinophilic granulomatosis with polyangiitis accompanied by heart failure mimicking an asthma attack

Eosinophilic granulomatosis with polyangiitis (EGPA, also known as the Churg-Strauss syndrome) is a disorder characterized by asthma, peripheral eosinophilia and systemic vasculitis. It rarely occurs in children, so that physicians may frequently mistake it for a simple uncontrolled asthma. Since a subsequent cardiac involvement is critical for the prognosis, it is important to suspect EGPA in children with severe, uncontrolled asthma. The cardiac manifestations in EGPA are variable from asymptomatic electrocardiogram abnormalities to pericarditis with pericardial effusion, myocarditis with cardiomyopathy, heart failure, and sudden cardiac death. Although delayed treatment may lead to fatal cardiac complications in EGPA, adequate immune suppression can reverse cardiac impairment. We report a 14-year-old girl with persistent asthma refractory to steroids who was eventually diagnosed with an anti-neutrophil cytoplasmic antibody-negative EGPA.