Disseminated Histoplasmosis-Associated Cardiac Tamponade in a Patient With Acquired Immunodeficiency Syndrome

Abstract

We describe a case of a 57-year-old Caribbean-Black male with a medical history of concealed human immunodeficiency virus/acquired immunodeficiency syndrome who presented with cardiac tamponade (CT) secondary to disseminated histoplasmosis. The patient underwent emergent pericardiocentesis with immediate normalization of his hemodynamic status and resolution of obstructive shock. The clinician should consider atypical etiologies of CT, such as opportunistic infections in patients with HIV/AIDS.

Keywords: cardiac tamponade (CT); disseminated histoplasmosis (DH); human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS); pericardial effusion; pericardiocentesis.

Figure 1.

The patient’s bedside transthoracic echocardiogram and practical aspects of the emergent pericardiocentesis. (A) The parasternal long-axis echocardiographic view demonstrating a large circumferential pericardial effusion with tamponade physiology, demarcated by the asterisks. (B) Emergent pericardiocentesis was performed under fluoroscopy in the cardiac catheterization laboratory. The red arrow indicates a 6 French femoral Prelude^® sheath (Merit Medical Systems Inc., South Jordan, UT, USA) with a 6 French Expo™ pigtail catheter (Boston Scientific, Marlborough, MA, USA) encircled in red. (C) The sub-xiphoid approach to pericardiocentesis was performed under fluoroscopic and ultrasound-guidance. The green circle indicates the implanted 6 French femoral Prelude sheath (Merit Medical Systems Inc.) attached to a 6 French Expo pigtail catheter (Boston Scientific, Marlborough, MA, USA). (D) Our technique involved connecting the pigtail catheter to a negative suction container encircled in green, which rapidly relieved the tamponade physiology and normalized the patient’s obstructive shock. This strategy removed voluminous pericardial fluid quickly (~460 mL within 5-10 minutes).