Hemopericardium in an Infant
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SCIENTIFIC LETTER
Hemopericardium in an Infant Vishnu Mohan 1 & Pediredla Karunakar 1 & C.G. Delhikumar 1 & Avinash Anantharaj 2 & Abraar Sheriff 1 & Kiruthiga Sugumar 1 & Vivek Kattungal Anil 1 & Mohankumar Shivaprasad 1 Received: 21 July 2020 / Accepted: 7 October 2020 # Dr. K C Chaudhuri Foundation 2020
To the Editor: A 10-mo-old male infant presented with fever for 2 d followed by fast breathing for 7 d and not associated with any rash. On examination, he was afebrile with muffled heart sounds and decreased air entry on the left hemithorax. His anthropometry was normal. Electrocardiogram showed electrical alternans. Cardiomegaly with well-defined heart borders was prominent on chest X-ray. A clinical diagnosis of pericardial effusion with left side pleural effusion was suspected and the same was confirmed by an echocardiogram. Blood investigations revealed microcytic hypochromic anemia (7.4 g/dl), leucocytosis (21.1 × 109/L) with lymphocyte predominance (66%), and thrombocytosis (654 × 10 9 /L). Pericardiocentesis was performed due to the tamponade effect. A pigtail catheter was inserted in the pericardial sac for intermittent aspiration. Pleural effusion was minimal that resolved spontaneously. Pericardial fluid (PF) was grossly hemorrhagic, showed total leucocyte count of 300 cells/cumm with differential count of 2% neutrophils and 98% lymphocytes. Workup for tuberculosis, bacterial & fungal infections and malignancies was negative. PF for Human herpes virus-7 (HHV-7) real time polymerase chain reaction (PCR) was reported positive. A positive serum HHV-7 real time PCR further consolidated the diagnosis. He had two episodes of generalized tonic-clonic seizures on day 5 of hospital stay. Cerebrospinal fluid (CSF) analysis showed no cells with glucose 52 mg/dl (normal: >50 mg/ dl) and protein 47 mg/dl (normal: 25–50 mg/dl) were unremarkable. CSF culture was sterile. CSF HHV-7 real time
PCR was negative. Neuroimaging was non-contributory. The seizures were considered to be atypical febrile seizures. The pericardial drain was removed on day 12 of the hospital stay. He was discharged with no neurological deficit. Hemopericardium in children can occur due to tuberculosis, malignancy, uremia, aortic dissection, cardiac pacemaker or catheter insertion, blunt or penetrating chest trauma. Chlamydophila pneumoniae and Staphylococcus aureus are rarely reported as etiologies [1]. The majority (90%) of the primary HHV-7 infections are either nonapparent or manifest as a febrile illness with or without exanthematous rash in less than 10 y olds and transmitted from healthy adults to the children by saliva [2]. Exanthema subitum, hepatitis, febrile seizures, meningitis, encephalitis, acute infantile hemiplegia, acute disseminated encephalomyelitis, and Guillain-Barré syndrome have been described with HHV-7. Ozdemir et al. reported two cases of HHV-7 pericardial effusion [3]. To our knowledge, this is the first reported case of HHV-7 hemopericardium in infancy. Erosions of the pericardial blood vessels due to infection and t
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