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Case Reports
. 2017 Aug 30;17(1):597.
doi: 10.1186/s12879-017-2689-x.

Acute rhabdomyolysis and delayed pericardial effusion in an Italian patient with Ebola virus disease: a case report

Emanuele Nicastri  1 , Antonio Brucato  2 , Nicola Petrosillo  3 , Gianluigi Biava  3 , Timothy M Uyeki  4 , Giuseppe Ippolito  3 ; INMI’s Ebola Team
Collaborators, Affiliations
Case Reports

Acute rhabdomyolysis and delayed pericardial effusion in an Italian patient with Ebola virus disease: a case report

Emanuele Nicastri et al. BMC Infect Dis. .

Abstract

Background: During the 2013-2016 West Africa Ebola virus disease (EVD) epidemic, some EVD patients, mostly health care workers, were evacuated to Europe and the USA.

Case presentation: In May 2015, a 37-year old male nurse contracted Ebola virus disease in Sierra Leone. After Ebola virus detection in plasma, he was medically-evacuated to Italy. At admission, rhabdomyolysis was clinically and laboratory-diagnosed and was treated with aggressive hydration, oral favipiravir and intravenous investigational monoclonal antibodies against Ebola virus. The recovery clinical phase was complicated by a febrile thrombocytopenic syndrome with pericardial effusion treated with corticosteroids for 10 days and indomethacin for 2 months. No evidence of recurrence is reported.

Conclusions: A febrile thrombocytopenic syndrome with pericardial effusion during the recovery phase of EVD appears to be uncommon. Clinical improvement with corticosteroid treatment suggests that an immune-mediated mechanism contributed to the pericardial effusion.

Keywords: Ebola Virus Disease; Pericardial effusion; Rhabdomyolysis.

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Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Written informed consent was obtained from the patient for publication of this case report and any accompanying images.

The INMI’s Institutional Ethical Board assessed the criteria for access to experimental drugs and invasive procedures, approved informed consent form and analyzed ethical issues and possible solutions to minimize the physical and psychological harm for the patient. The patient signed an informed consent for any single procedure or treatment performed, after thoroughly explanation of reasonably anticipated benefits and potential hazards of intervention.

Emergency Use Authorization for investigational new drugs was issued by the Italian Drug Agency (AIFA), the authority entitled to approve medical agents to be used for therapy of disease when they are not the standard of care or supported by research that proves their safety.

Competing interests

The authors declare that they have no competing interest.

Disclaimer: The views expressed are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Ebola plasma viral load, creatine kinase levels, platelet count, timing of drug administration and of occurrence of the thrombocytopenic febrile syndrome (panel a); Skin lesions on the face and on the left thigh, and neck adenopathy (panels b-d); Echocardiographic evidence of MILD circumferential pericardial effusion at the time of the thrombocytopenic febrile syndrome and ECG showing ECG showed diffuse nonspecific abnormalities (panels e and f). Legend of panel A: The Y-axis indicates Ebola viral load (copies/ml) and platelet count (platelet/mm3). The Z-axis indicates creatine kinase levels (International Units/Liter). CK creatine kinase
See this image and copyright information in PMC

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