TY - JOUR
T1 - Heart failure enigma in young man
T2 - The acute onset of a frequently encountered condition with an unexpected cause
AU - Leonor Lopez, George Luis
AU - Chaparro, Sandra Viviana
AU - Brozzi, Nicholas
AU - Badiye, Amit
N1 - Publisher Copyright:
© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2020/1/19
Y1 - 2020/1/19
N2 - An 18-year-old male patient presented to the emergency department complaining of new onset chest pain, fever and orthopnoea. Initial workup was remarkable for elevated troponin, diffuse ST-segment elevation on ECG and chest X-ray with enlarged cardiac silhouette. Transthoracic echocardiogram (TTE) demonstrates severe biventricular concentric hypertrophy and pericardial effusion. Also, Coxsackie virus A and B titres were positive, concerning for a classic viral pericarditis. However, despite medical management, the patient became dyspnoeic and hypotensive. Impending cardiac tamponade was observed on repeat TTE, and pericardiocentesis was performed, complicated by pulseless electrical activity cardiac arrest, and ultimately patient requiring venoarterial extracorporeal membrane oxygenation support. Emergent endomyocardial biopsy showed no inflammatory process, and a skin biopsy of a small lesion in the right arm showed unexpected diagnosis of Epstein-Barr virus (+) natural killer/T-cell lymphoma. On initiation of chemotherapy, clinical improvement was observed as evidenced by improving ejection fraction, resolution of pericardial effusion and gradual decrease in myocardial hypertrophy.
AB - An 18-year-old male patient presented to the emergency department complaining of new onset chest pain, fever and orthopnoea. Initial workup was remarkable for elevated troponin, diffuse ST-segment elevation on ECG and chest X-ray with enlarged cardiac silhouette. Transthoracic echocardiogram (TTE) demonstrates severe biventricular concentric hypertrophy and pericardial effusion. Also, Coxsackie virus A and B titres were positive, concerning for a classic viral pericarditis. However, despite medical management, the patient became dyspnoeic and hypotensive. Impending cardiac tamponade was observed on repeat TTE, and pericardiocentesis was performed, complicated by pulseless electrical activity cardiac arrest, and ultimately patient requiring venoarterial extracorporeal membrane oxygenation support. Emergent endomyocardial biopsy showed no inflammatory process, and a skin biopsy of a small lesion in the right arm showed unexpected diagnosis of Epstein-Barr virus (+) natural killer/T-cell lymphoma. On initiation of chemotherapy, clinical improvement was observed as evidenced by improving ejection fraction, resolution of pericardial effusion and gradual decrease in myocardial hypertrophy.
KW - cancer - see oncology
KW - heart failure
KW - oncology
UR - http://www.scopus.com/inward/record.url?scp=85078463979&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85078463979&partnerID=8YFLogxK
U2 - 10.1136/bcr-2019-233190
DO - 10.1136/bcr-2019-233190
M3 - Article
C2 - 31959653
AN - SCOPUS:85078463979
VL - 13
JO - BMJ Case Reports
JF - BMJ Case Reports
SN - 1757-790X
IS - 1
M1 - e233190
ER -