Cardiac tamponade caused by acute coxsackievirus infection related pericarditis complicated by aortic stenosis in a hemodialysis patient: a case report

Abstract

BackgroundPericardial effusion is observed in the majority of viral pericarditis cases; however, viral pericarditis accompanied by a large effusion resulting in cardiac tamponade is rare.Case presentationHere, we report the case of a 75-year-old hemodialysis patient with acute viral pericarditis complicated by aortic stenosis. The patient was referred with a diagnosis of aortic stenosis and pericardial effusion. The pericardial effusion had increased during the preoperative examinations, and the inflammatory reaction had progressed. We decided to abort the surgical intervention and start oral administration of anti-inflammatory agents. We subsequently performed a pericardiocentesis. High antibody titers to coxsackievirus were noted in the pericardial effusion. Since no recurrence of the pericardial effusion was observed, the patient underwent an aortic valve replacement 2 months later. The pericardium completely adhered to the heart. Pathological examination of the pericardium showed fibrous pericarditis without active inflammation.ConclusionsHere, we successfully treated a hemodialysis case with severe aortic stenosis complicated by cardiac tamponade and worsened by acute viral pericarditis. We waited for the pericarditis to resolve after administering anti-inflammatory agents and performed pericardial drainage before carrying out aortic valve replacement. The perioperative course of our case was unique and suggestive.

Post COVID-19 hemorrhagic pericardial effusion; A case report with literature review

“…According to the existing literature, most reports of COVID-19 related PE were non-hemorrhagic, with only a few hemorrhagic cases being present [ 9 , 14 ]. This makes COVID-19 the second viral infection that can lead to hemorrhagic PE, in addition to Coxsackievirus [ 15 ].…”

Life-Threatening Cardiac Tamponade Secondary to COVID-19 Treated with Uniportal Video-Assisted Thoracoscopic Surgery: A Case Report

“…Our patient was free from any diseases, such as connective tissue disorder, malignancy, endocarditis, myocarditis, and pericarditis. Little is known about the association between hemorrhagic pericardial effusion and viral infections; however, it has been linked to the Coxsackie virus [ 37 ].…”

A Case of Hemorrhagic Cardiac Tamponade in a Patient with COVID-19 Infection

“…Although not as common, viral pericarditis can cause hemorrhagic pericardial effusion, especially Coxsackie virus. [5][6][7] Two possible mechanisms for this phenomenon are direct cytotoxic activity by the virus Figure 3 Echocardiography before pericardiocentesis: transthoracic echocardiography showed pericardial effusion (yellow arrow), with signs of tamponade (not depicted). The patient underwent emergent pericardiocentesis.…”