title: Late constrictive involvement of the pericardium in a case of previous myocarditis.
abstract: Constrictive pericarditis (CP) is a highly relevant disease clinically because pericardiectomy represents the only curative therapeutic approach. Previous cardiac surgery or mediastinal radiation may cause CP, however, infectious agents account for a substantial portion of CP. In this report, we present a patient with previous biopsy-proven myocarditis and positive seroconversion against coxsackievirus B3 without clinical evidence of acute pericardial involvement who developed CP after a prolonged period of time. This suggests that infectious particles primarily infecting the myocardium may lead to chronic inflammatory responses of the pericardium, thus causing CP even at late clinical stages. This case emphasizes the important fact that primary myocarditis may not only cause systolic ventricular impairment but may also induce diastolic dysfunction of the heart, either as restrictive cardiomyopathy or, as in this case, through inflammatory involvement of the pericardium, leading to CP.
authors.affiliation: Deutsches Herzzentrum und 1. Medizinische Klinik, Technische Universität, Munich, Germany. rwessely@dhm.mhn.de
authors.forename: Rainer
authors.initials: R
authors.lastname: Wessely
authors.forename: Marc
authors.initials: M
authors.lastname: Vorpahl
authors.forename: Albert
authors.initials: A
authors.lastname: Schömig
authors.forename: Karin
authors.initials: K
authors.lastname: Klingel
mesh_terms: D000914:Antibodies, Viral / Q000097:blood; D003971:Diastole; D029822:Enterovirus B, Human / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000150:complications* / Q000473:pathology; D010494:Pericarditis, Constrictive / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D010496:Pericardium / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000473:pathology / Q000503:physiopathology
chemical_list: D000914:Antibodies, Viral