ABSTRACT
Ankylosing spondylitis (AS) is a rheumatological disorder of the spine, and like many other rheumatological diseases, it can manifest as a systemic inflammation. We present a rare case of cardiac manifestations of AS in a 25-year-old man with recurrent chest pain and pericardial effusions. He initially presented with pleuritic chest pain, was diagnosed with cardiac tamponade and required emergent pericardiocentesis. The patient returned again with chest pain and was found to have reaccumulation of pericardial effusion. The cardiac symptoms were finally resolved when he was diagnosed and treated for AS.
Subject(s)
Cardiac Tamponade/diagnosis , Pericardial Effusion/diagnosis , Spondylitis, Ankylosing/diagnosis , Adalimumab/administration & dosage , Adalimumab/therapeutic use , Adult , Cardiac Tamponade/complications , Cardiac Tamponade/diagnostic imaging , Cardiac Tamponade/therapy , Chest Pain/etiology , Diagnosis, Differential , Echocardiography , Humans , Male , Pericardial Effusion/complications , Pericardial Effusion/diagnostic imaging , Pericardial Effusion/therapy , Pericardiocentesis , Spondylitis, Ankylosing/complications , Spondylitis, Ankylosing/diagnostic imaging , Spondylitis, Ankylosing/drug therapy , Tumor Necrosis Factor-alpha/antagonists & inhibitorsSubject(s)
Anti-Bacterial Agents/therapeutic use , Coronary Sinus/diagnostic imaging , Endocarditis/diagnostic imaging , Endocarditis/drug therapy , Adult , Ceftazidime/therapeutic use , Diagnosis, Differential , Endocarditis/complications , Female , Follow-Up Studies , Gentamicins/therapeutic use , Humans , Hypertension/complications , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , Meropenem , Renal Dialysis/methods , Thienamycins/therapeutic use , Treatment Outcome , Ultrasonography , Young AdultABSTRACT
Lemierre's syndrome is an uncommon complication of pharyngitis commonly associated with an anaerobic gram negative bacterium, Fusobacterium necrophorum. The syndrome usually affects young healthy adults with the mean age of 20 and is characterized by recent pharyngitis followed by ipsilateral internal jugular vein thrombosis and septic thromboembolism. The treatment is at least 6 weeks of antibiotics; the role of anticoagulation is unclear. The following presentation is a case of Lemierre's syndrome in a 23-year-old healthy individual who is infected by a rare species: Fusobacterium nucleatum. The case is complicated by septic emboli to the lungs and impressive seeding vegetation to the right ventricular outflow tract (RVOT) at the pulmonic valve of the heart.
