A CASE OF ACUTE PERICARDITIS DUE TO RESPIRATORY SYNCYTIAL VIRUS IN A HEALTHY ADULT

Document Type

Conference Proceeding

Publication Date

6-17-2022

Publication Title

J Gen Intern Med

Abstract

CASE: Acute pericarditis in immunocompetent adults commonly occurs due to a viral infection or idiopathic etiologies. Although the culprit viruses are rarely identified, those implicated include Coxsackievirus, Echovirus, Adenovirus and Influenza. Review of literature identified one report of acute pericarditis associated with Respiratory Syncytial Virus (RSV) that occurred in an immunocompromised patient. We present a case of a healthy adult who developed RSV-associated acute pericarditis. A 42-year-old man with a history of hypertension presented with acute sharp substernal chest pain that was exacerbated by inspiration. He had a temperature of 38.5°C, blood pressure of 174/113 mmHg, respiratory rate of 18, and oxygen saturation of 96% on room air. Physical examination was noncontributory. The patient had an elevated high-sensitivity troponin with a small peak of 74 ng/L and an elevated BNP of 397 pg/mL. Further investigations revealed lymphopenia and elevated c-reactive protein. Chest x-ray and CT pulmonary angiogram were unremarkable for an acute process. ECG showed widespread ST segment elevation. Testing for Influenza A and B, SARS-CoV-2, and Legionella was negative and blood cultures showed no growth. However, a viral respiratory panel detected RSV. Further history revealed that the patient's children had developed a febrile illness with nasal congestion, rhinorrhea, and cough one week prior to his presentation; this was identified as the likely source of transmission. The patient was diagnosed with viral acute pericarditis and treated with colchicine and NSAIDs after which his symptoms rapidly resolved. IMPACT/DISCUSSION: Initial concern was for a possible ST elevation myocardial infarction, however, the clinical picture appeared to be more consistent with pericarditis. Transthoracic echocardiogram revealed the presence of a small circumferential pericardial effusion and a preserved left ventricular ejection fraction of 55% without wall motion abnormality. The decision was made to defer coronary angiography due to the low likelihood of an ischemic etiology. The implication of RSV as a cause of acute pericarditis in otherwise healthy immunocompetent adults is rare, however, there is an increasing recognition of its association with cardiovascular complications which may be related to the induction of a pro-inflammatory state. The growing recognition of RSV's adverse public health impact is driving interest in the development and broader use of vaccines against RSV. Regardless of etiology, the treatment of viral pericarditis is similar and involves a course of colchicine and NSAIDs; systemic corticosteroids should be avoided. CONCLUSION: We report a case of RSV-associated acute pericarditis in a healthy adult. Clinical diagnosis is made by identification of characteristic symptoms, ECG changes and pericardial effusion. Viral infection is the leading cause of acute pericarditis and identification of exposure in addition to viral testing can help confirm the etiology.

Volume

37

First Page

S382

Last Page

S383

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