Hemorrhagic Pericardial Effusion: Diagnotic Dilemna

Le résumé fourni par la source

WINCARSA 48 year old female presented with fever, cough and shortness of breath of 1 week duration with toxic look in congestive heart failure.There was sinus tachycardia on ECG, pulmonary edema on chest radiography, global hypokinesia of the left ventricle with severe left ventricular dysfunction on echocardiogram.Total leukocyte count was elevated, LFT was abnormal, grossly elevated cardiac enzymes and acute kidney injury.Possible diagnosis was acute myocarditis and patient started on decongestive therapy.24 hours later, patient developed massive effusion with tamponade.Pericardiocentesis was done and hemorrhagic fluid (700 ml) was tapped.Fluid was exudate, negative for ADA and malignant cells but positive for ANA.Rheumatologist opined to be undifferentiated CTD/ scleroderma not SLE and started on steroids and immunosuppressive drugs.Patient improved symptomatically and a pre discharge echocardiogram

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