A clinical enigma of ongoing constrictive pericarditis

Abstract

A 59-year-old lady presented with a 1-week history of orthopnoea, paroxysmal nocturnal dyspnoea, night sweats and a productive cough. She had no recent history of travel. Transthoracic echocardiogram revealed preserved left ventricular systolic function with abnormal pericardial thickening and restrictive left ventricular filling consistent with pericardial constriction. Cardiac magnetic resonance imaging confirmed a globally thickened pericardium and showed evidence of pericardial inflammation and constrictive physiology. She did not respond to diuresis, pulsed intravenous steroids or broad spectrum antibiotics and multiple investigations were negative, including autoimmune screen and tuberculosis cultures. Eventually a serum sample was found to be positive for Strongyloides stercoralis and it emerged that this lady had travelled to Egypt 8 years previously, where it is thought that she contracted S stercoralis leading to her developing constrictive pericarditis. This case report summarises the presentation and progression of this case and rare diagnosis.

Keywords: Cardiology; Strongyloides stercoralis; pericardial disease; pericarditis.

Fig 1.

Echocardiogram showing parasternal long axis. See supplementary file (Video S1) for video demonstrating abnormal pericardial filling and restrictive left ventricular filling.

Fig 2.

Echocardiogram showing apical view. See supplementary file (Video S2) for video showing septal bounce consistent with pericardial constriction.

Fig 3.

Cardiac magnetic resonance image. See supplementary file (Video S3) for video showing evidence of pericardial inflammation and constrictive physiology.