Acute Myeloid Leukemia Presenting as Effusive Constrictive Pericarditis

An Unusual Case of Effusive-Constrictive Pericarditis in the Intensive Care Unit

“…Lutz et al. 5 previously reported a similar case of AML presenting as cardiac tamponade and ECP. In contrast to this previous case report, our patient was critically ill and required IMPPV, which could demonstrate the interesting interaction between mechanical ventilation and pericardial diseases.…”

“…Cardiac tamponade was a rare clinical manifestation of AML, limited to only isolated case reports. 5 In a case series involving 2,592 patients with AML, acute lymphocytic leukemia, or myelodysplastic syndrome, only 20% of patients had echocardiographic evidence of pericardial effusion, while only 3% of the cases required pericardiocentesis due to tamponade. 6 The event of hemorrhagic pericardial effusion with tamponade occurred acutely in our patient, as evidenced by a marked increase in pericardial effusion and new findings of tamponade effect 3 days after the initial echocardiographic assessment.…”

“… 11 The use of colchicine, nonsteroidal anti-inflammatory drugs, or steroids in ECP were reported in existing literature. 5 , 13 In a study of 33 patients with ECP, 92% (24 of 26 patients who followed up and had progress echocardiography) showed clinical and echocardiographic resolution of ECP features following medical therapy. 13 Surgical pericardiectomy was performed in selected candidates with poor response to medical treatment.…”

“…Most patients with ECP had favorable outcomes. 5 , 13 Mortality has been reported in patients with underlying malignancy. 13 Spontaneous resolution of ECP was observed in cases of idiopathic etiology.…”

Leukemic Infiltration of Myocardium Presenting as Cardiac Arrest

“…Cardiac tamponade was found in 3% of patients in this cohort. Proposed mechanisms for pericardial disease include leukemic infiltration, increased susceptibility to bleeding due to thrombocytopenia, and increased risk of infection due to an immunocompromised state ( 6 ). Conduction defects due to leukemic involvement may also manifest with cardiac arrhythmias.…”