title: Post-operative constrictive pericarditis complicated with lymphocytopenia and hypoglobulinemia.
abstract: A 71-year-old man who had a history of open chest surgery was admitted due to anasarca and bilateral pleural effusions. Although imaging modalities could not demonstrate any pericardial abnormalities, right-sided cardiac catheterization revealed 'dip and plateau' in diastolic pressure waveform. He was admitted frequently because of the episodic right-sided congestive heart failure and hypoproteinemia due to protein-losing enteropathy. The peripheral lymphocyte count and serum gamma-globulin concentration were gradually decreased, and finally showed lymphocytopenia and hypoglobulinemia. On the last admission, the patient showed extensive cellulitis on both legs, and he developed septicemia, and finally died due to septic shock. Post-mortem examination showed that both visceral and parietal layers of the pericardium adhered tightly with mediastinal fibrosis. This case report suggested that constrictive pericarditis should be considered even if there is a lack of typical abnormal pericardial imaging findings when patients have a history of open chest surgery and recurrent right-sided congestive heart failure. In addition, we should be aware of a serious outcome due to immune compromised conditions such as lymphocytopenia and dysglobulinemia in this disorder.
authors.affiliation: Second Department of Internal Medicine, Iwate Medical University, Morioka.
authors.forename: Masaki
authors.initials: M
authors.lastname: Ohsawa
authors.forename: Motoyuki
authors.initials: M
authors.lastname: Nakamura
authors.forename: Li-hua
authors.initials: LH
authors.lastname: Pan
authors.forename: Takehito
authors.initials: T
authors.lastname: Shizuka
authors.forename: Jun-ichi
authors.initials: J
authors.lastname: Nakagawa
authors.forename: Hirobumi
authors.initials: H
authors.lastname: Ishida
authors.forename: Mami
authors.initials: M
authors.lastname: Ouchi
authors.forename: Takahiro
authors.initials: T
authors.lastname: Shiroto
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Hotta
authors.forename: Takashi
authors.initials: T
authors.lastname: Sawai
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Hiramori
mesh_terms: D000361:Agammaglobulinemia / Q000150:complications*; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D004927:Escherichia coli Infections / Q000150:complications / Q000175:diagnosis; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis; D006801:Humans; D008231:Lymphopenia / Q000150:complications*; D008297:Male; D010494:Pericarditis, Constrictive / Q000150:complications / Q000175:diagnosis*; D011504:Protein-Losing Enteropathies / Q000150:complications*; D012772:Shock, Septic / Q000150:complications / Q000175:diagnosis