title: Effusive-constrictive pericarditis, hepatitis, and pancreatitis in a patient with possible coxsackievirus B infection: a case report.
abstract: BACKGROUND
  Coxsackie B is a viral pathogen that presents with various invasive diseases in adults. Historically, the majority of adult cases with pericarditis or myocarditis have been attributed to coxsackievirus B. The presentation of this viral infection causing effusive-constrictive pericarditis, hepatitis or pancreatitis is rare. This case report is the first to describe a patient with concomitant effusive-constrictive pericarditis, hepatitis and pancreatitis from possible coxsackievirus B infection.
  
  
  METHODS
  A 26-year old female was admitted to our hospital with the diagnosis of effusive-constrictive pericarditis complicated by tamponade and cardiac arrest. An emergent pericardiocentesis was performed successfully. Hepatitis and pancreatitis were also identified in our patient. After an extensive workup, coxsackievirus B infection was suspected by positive serum complement fixation antibody titers. Our patient made a full recovery and was discharged from the hospital.
  
  
  CONCLUSIONS
  Clinical suspicion of effusive-constrictive pericarditis with tamponade from coxsackievirus B should be considered in patients presenting with chest pain, dyspnea, jugular venous distention, hypotension, ST segment elevation on electrocardiogram, and ventricular interdependence with septal shift during diastole on transthoracic echocardiogram. Initial diagnoses of effusive-constrictive pericarditis resembling cardiac tamponade, hepatitis and pancreatitis can be challenging, and this case highlights the need for healthcare professionals to be cognizant of the association between these unusual clinical presentations and coxsackievirus B infection.
authors: Department of Internal Medicine, Riverside University Health System Medical Center, 26520 Cactus Avenue, Moreno Valley, CA, 92555, USA. j.persichino@ruhealth.org.
authors: Jon
authors: J
authors: Persichino
authors: Department of Internal Medicine, Riverside University Health System Medical Center, 26520 Cactus Avenue, Moreno Valley, CA, 92555, USA.
authors: Roger
authors: R
authors: Garrison
authors: Division of Cardiology, Riverside University Health System Medical Center, Moreno Valley, CA, USA.
authors: Rajagopal
authors: R
authors: Krishnan
authors: Division of Infectious Diseases, Riverside University Health System Medical Center, Moreno Valley, CA, USA.
authors: Made
authors: M
authors: Sutjita
mesh_terms: D000328:Adult; D002305:Cardiac Tamponade / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D003384:Coxsackievirus Infections / Q000150:complications / Q000175:diagnosis* / Q000821:virology; D004452:Echocardiography; D004562:Electrocardiography; D029822:Enterovirus B, Human; D005260:Female; D006323:Heart Arrest / Q000209:etiology; D006525:Hepatitis, Viral, Human / Q000150:complications / Q000175:diagnosis* / Q000821:virology; D006801:Humans; D010195:Pancreatitis / Q000150:complications / Q000175:diagnosis* / Q000821:virology; D010490:Pericardial Effusion / Q000150:complications / Q000175:diagnosis* / Q000628:therapy / Q000821:virology; D020519:Pericardiocentesis; D010494:Pericarditis, Constrictive / Q000150:complications / Q000175:diagnosis* / Q000821:virology
keywords: Coxsackie B; Effusive-constrictive pericarditis; Hepatitis; Pancreatitis