93211_ActaCardio_65-1_14_09-3791
11-02-2010
Acta Cardiol 2010; 65(1): 83-84
CASE
12:56
Pagina 83
83
doi: 10.2143/AC.65.1.2045894
REPORT
Sarcoidosis: an unusual cause of acute pericarditis
Benjamin WYPLOSZ1, MD, PhD; Eloi MARIJON2, MD; Julie DOUGADOS3, MD; Jacques POUCHOT3, MD 1Unité
de maladies infectieuses et tropicales, Hôpital Paul Brousse, Villejuif, Assistance Publique des hôpitaux de Paris (AP-HP), Université Paris-Sud 11; 2Département de cardiologie, et 3Département de médecine interne, Hôpital européen Georges Pompidou, Paris, AP-HP, Université Paris-Descartes, France. Mild to moderate asymptomatic pericardial effusions are commonly detected in patients with biopsyproven sarcoidosis. However, symptomatic pericarditis is rare during the course of the disease. All reported cases at presentation were life-threatening tamponades. We describe the first case of a patient in whom sarcoidosis was revealed by an acute benign pericarditis persisting despite administration of colchicine and non-steroidal anti-inflammatory drugs. Similar cases may have been ignored since the initial diagnosis of sarcoidosis is challenging and corticosteroids are frequently given to patients with persistent chest pain. Clinicians should consider the possibility of sarcoidosis in case of pericarditis resistant to first-line therapy. Keywords: Acute pericarditis – sarcoidosis.
Although small or moderate asymptomatic pericardial effusions are frequently detected during the course of sarcoidosis, symptomatic pericarditis is rarely a presenting clinical feature. All reported cases have consisted of life-threatening tamponade treated by pericardiocentesis or pericardiotomy. We report a case of sarcoidosis revealed by a benign acute pericarditis. Our observation suggests that clinicians should consider the diagnosis of sarcoidosis in the presence of acute pericarditis.
Case report A 19-year-old female Caucasian student was referred to our cardiology department (Hôpital européen Georges Pompidou) with a 10-day history of retrosternal chest pain with dyspnoea, fatigue and fever. She was a non-smoker with no significant past medical history. Seven days before admission, her general practitioner had diagnosed a presumptive idiopathic acute pericarditis. Acetylsalicylic acid was administered but the symptoms did not resolve. When first admitted, physical examination showed an isolated well-tolerated
Address for correspondence: Dr. Benjamin Wyplosz, MD, PhD, Unité de Maladies Infectieuses et Tropicales, Hôpital Paul Brousse, 12, avenue Paul-Vaillant-Couturier, 94804 Villejuif Cedex, France. E-mail:
[email protected] Received 20 May 2009; accepted for publication 27 May 2009.
tachycardia, with no evidence of right heart failure. An electrocardiogram disclosed sinus tachycardia and negative T-waves in leads V1, V2 and V3. C-reactive protein (CRP) serum level was elevated to 104∞∞mg/L. Haemogram, serum creatinine, liver enzymes, thyroidstimulating hormone, troponin and myoglobin were within the reference range values. A standard chest radiograph was reported to be normal. Transthoracic echocardiography showed a 6-mm thick posterior pericardial effusion without other cardiac abnormalities. Acetylsalicylic acid was withdrawn and ketoprofen and colchicine were administered and the patient was discharged. Because of persisting chest pain and fever during the next 2∞∞weeks, the patient was readmitted. Clinical examination and the electrocardiogram were unchanged. CRP serum level was 39∞∞mg/L; haemogram and routine biochemical analyses were normal. Investigations were negative for Mycoplasma pneumoniae, hepatitis B and C viruses, human immunodeficiency virus infection and auto-antibodies (anti-DNA, antinuclear, and rheumatoid factor). A thoracic CT-scan revealed mild bilateral perihilar interstitial infiltration unnoticed at the first admission, and enlarged mediastinal lymph nodes (10-20∞∞mm). Fiber optic bronchoscopy showed a normal mucosa, but bronchoalveolar lavage revealed lymphocytic alveolitis. Histological examination of systematic bronchial biopsy specimens showed multiple granulomas with epithelioid and multinucleated giant cells without necrosis or caseation, consistent with a diagnosis of sarcoidosis. Serum levels
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of calcium and activity of angiotensin-converting enzyme were normal (15.9∞∞mU/ml, reference range
