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Case Reports
. 2020 Sep 26;12(9):460-467.
doi: 10.4330/wjc.v12.i9.460.

Pericardial effusion with tamponade - an uncommon presentation leading to the diagnosis of eosinophilic granulomatosis polyangiitis: A case report

Loba Alam  1 , Glenmore Lasam  2 , Robert Fishberg  3
Affiliations
Case Reports

Pericardial effusion with tamponade - an uncommon presentation leading to the diagnosis of eosinophilic granulomatosis polyangiitis: A case report

Loba Alam et al. World J Cardiol. .

Abstract

Background: Eosinophilic granulomatosis polyangiitis (EGPA) is a small vessel necrotizing vasculitis that commonly presents as peripheral eosinophilia and asthma; however, it can rarely manifest with cardiac involvement such as pericarditis and cardiac tamponade. Isolated pericardial tamponade presenting as the initial symptom of EGPA is exceedingly rare. Early diagnosis and appropriate treatment are crucial to prevent life-threatening outcomes.

Case summary: 52-year-old woman with no past medical history presented with progressive dyspnea and dry cough. On physical exam she had a pericardial friction rub and bilateral rales. Vital signs were notable for tachycardia at 119 beats per minute and hypoxia with 89% oxygen saturation. On laboratory exam, she had 45% peripheral eosinophilia, troponin elevation of 1.1 ng/mL and N-terminal prohormone of brain natriuretic peptide of 2101 pg/mL. TTE confirmed a large pericardial effusion and tamponade physiology. She underwent urgent pericardial window procedure. Pericardial and lung biopsy demonstrated eosinophilic infiltration. Based on the American College of Radiology guidelines, the patient was diagnosed with EGPA which manifested in its rare form of cardiac tamponade. She was treated with steroid taper and mepolizumab.

Conclusion: This case highlights that when isolated pericardial involvement occurs in EGPA, diagnosis is recognized by performing pericardial biopsy demonstrating histopathologic evidence of eosinophilic infiltration.

Keywords: Cardiac tamponade; Case report; Eosinophilic granulomatosis polyangiitis; Mepolizumab; Pericardial biopsy; Pericardial effusion; Peripheral eosinophilia.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare no potential financial interests.

Figures

Figure 1
Figure 1
Electrocardiogram showed sinus tachycardia, low voltage QRS (arrows) with small ST-T wave changes.
Figure 2
Figure 2
Chest radiograph revealed cardiomegaly (line) and bilateral opacities (arrows).
Figure 3
Figure 3
Chest computed tomography angiogram revealed a large pericardial effusion (arrow); moderate right and small left pleural effusion (arrowhead).
Figure 4
Figure 4
Transthoracic echocardiogram showed large pericardial effusion (arrowhead).
Figure 5
Figure 5
Cardiac biopsy revealed pericardial thickening with eosinophil predominant infiltrate (arrow).
Figure 6
Figure 6
Lung biopsy revealed organizing inflammatory infiltrate, micro abscess (arrow), and eosinophil infiltrate.
See this image and copyright information in PMC

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