title: Cardiac tamponade due to low-volume effusive constrictive pericarditis in a patient with uncontrolled type II autoimmune polyglandular syndrome.
abstract: Type II autoimmune polyglandular syndrome (APS), a relatively common endocrine disorder, includes primary adrenal insufficiency coupled with type 1 diabetes mellitus and/or autoimmune primary hypothyroidism. Autoimmune serositis, an associated disease, may present as symptomatic pericardial effusion. We present a case of a 54-year old male with APS who developed pericarditis leading to cardiac tamponade with a subacute loculated effusion. After urgent pericardiocentesis intrapericardial pressure dropped to 0, while central venous pressures remain elevated, consistent with acute effusive constrictive pericarditis. Contrast computerized tomography confirmed increased pericardial contrast enhancement. The patient recovered after prolonged inotropic support and glucocorticoid administration. He re-accumulated the effusion 16 days later, requiring repeat pericardiocentesis. Effusive-constrictive pericarditis, an uncommon pericardial syndrome, is characterized by simultaneous pericardial inflammation and tamponade. Prior cases of APS associated with cardiac tamponade despite low volumes of effusion have been reported, albeit without good demonstration of hemodynamic findings. We report a case of APS with recurrent pericardial effusion due to pericarditis and marked hypotension with comprehensive clinical and hemodynamic assessment. These patients may require aggressive support with pericardiocentesis, inotropes, and hormone replacement therapy. They should be followed closely for recurrent tamponade.
authors.affiliation: Department of Gastroenterology and Hepatology, Mayo Clinic , Jacksonville, Florida , USA.
authors.forename: William C
authors.initials: WC
authors.lastname: Palmer
authors.forename: Andrew
authors.initials: A
authors.lastname: Kurklinsky
authors.forename: Gary
authors.initials: G
authors.lastname: Lane
authors.forename: Kamonpun
authors.initials: K
authors.lastname: Ussavarungsi
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Blackshear
mesh_terms: D001241:Aspirin / Q000627:therapeutic use; D002305:Cardiac Tamponade / Q000209:etiology* / Q000628:therapy; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003078:Colchicine / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005938:Glucocorticoids / Q000627:therapeutic use; D020249:Hormone Replacement Therapy; D006801:Humans; D007022:Hypotension / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000150:complications* / Q000628:therapy; D020519:Pericardiocentesis; D010494:Pericarditis, Constrictive / Q000150:complications* / Q000628:therapy; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D016884:Polyendocrinopathies, Autoimmune / Q000150:complications* / Q000628:therapy; D012008:Recurrence
chemical_list: D002316:Cardiotonic Agents; D005938:Glucocorticoids; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin; D003078:Colchicine