School of Medicine and Health Sciences Poster Presentations

Title

Recurrent pericarditis in a young man with asymptomatic Chlamydia urethritis

Document Type

Poster

Abstract Category

Immunology/Infectious Diseases

Keywords

Pericarditis, Chlamydia urethritis

Publication Date

Spring 5-1-2019

Abstract

A 33 year-old previously healthy man presented with a third episode of chest pain, dyspnea on exertion, and fevers. He had been discharged 2 weeks prior on colchicine and indomethacin after being diagnosed with acute pericarditis. Lab work showed mild leukocytosis, and an increased ESR and CRP. Echocardiogram showed pericardial effusion and tamponade physiology. Chest CT showed mediastinal lymphadenopathy and pericardial effusion. A pericardiocentesis was performed, with 400mL of grossly purulent fluid, with lymphocytic predominance, drained. A pericardial drain was also placed. Thorough history taking revealed that the patient had unprotected intercourse with female partners in recent months. A broad STI panel was sent, and urine PCR was positive for Chlamydia. The patient was started on azithromycin, which was switched to doxycycline due to side effects. The pericardial drain output reduced drastically, and it was removed after 7 days. Fluid cultures were all negative, and a validated Chlamydia PCR test for pericardial fluid was not available. Broad rheumatological workup was negative, except for an isolated positive anti ds-DNA. Symptoms did not reoccur. Chlamydial infections are a relatively uncommon cause of acute pericarditis and myocarditis worldwide, although there are significant uncertainties surrounding its incidence. In the era of rising STI incidence, improved characterization of their complications is imperative. The above case highlights the importance of keeping a broad differential when encountering “idiopathic” pericarditis and related clinical entities, and of using clinical diagnosis to complement the reliance on molecular testing, especially when considering unusual sites of infection.

Open Access

1

Comments

Presented at Research Days 2019.

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Recurrent pericarditis in a young man with asymptomatic Chlamydia urethritis

A 33 year-old previously healthy man presented with a third episode of chest pain, dyspnea on exertion, and fevers. He had been discharged 2 weeks prior on colchicine and indomethacin after being diagnosed with acute pericarditis. Lab work showed mild leukocytosis, and an increased ESR and CRP. Echocardiogram showed pericardial effusion and tamponade physiology. Chest CT showed mediastinal lymphadenopathy and pericardial effusion. A pericardiocentesis was performed, with 400mL of grossly purulent fluid, with lymphocytic predominance, drained. A pericardial drain was also placed. Thorough history taking revealed that the patient had unprotected intercourse with female partners in recent months. A broad STI panel was sent, and urine PCR was positive for Chlamydia. The patient was started on azithromycin, which was switched to doxycycline due to side effects. The pericardial drain output reduced drastically, and it was removed after 7 days. Fluid cultures were all negative, and a validated Chlamydia PCR test for pericardial fluid was not available. Broad rheumatological workup was negative, except for an isolated positive anti ds-DNA. Symptoms did not reoccur. Chlamydial infections are a relatively uncommon cause of acute pericarditis and myocarditis worldwide, although there are significant uncertainties surrounding its incidence. In the era of rising STI incidence, improved characterization of their complications is imperative. The above case highlights the importance of keeping a broad differential when encountering “idiopathic” pericarditis and related clinical entities, and of using clinical diagnosis to complement the reliance on molecular testing, especially when considering unusual sites of infection.