Emergent pericardiocentesis and subsequent immunosuppressive therapy successfully managed a 77-year-old male presenting with EGPA-related cardiac tamponade initially mimicking traumatic effusion.
Case Report (n=1)
Highlights the importance of considering systemic vasculitis like EGPA in patients presenting with unexplained pericardial effusion and cardiac tamponade, even after recent trauma.
Abstract Introduction Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic necrotizing vasculitis that primarily affects small- to medium-sized vessels. Cardiac involvement, while less common has been documented including myocarditis, coronary vasculitis, and pericardial disease. Pericardial effusion in EGPA is rare and may present insidiously or as a life-threatening complication such as cardiac tamponade. Description We present a 77-year-old male with history of hypertension, PTSD who initially presented to following motor vehicle crash involving the patient striking a tree on the side of the road. Trauma workup and CT imaging was unremarkable at the time and patient was discharged home. A month later patient returned to the ED with generalized weakness and poor oral intake. Further evaluation revealed shock with new atrial fibrillation, AKI with oliguria and shock liver. A large circumferential pericardial effusion was noted on CT imaging and pocus exam showed signs of cardiac tamponade. An emergent pericardiocentesis was performed with improvement in shock parameters. Patient was admitted to ICU for cardiogenic shock and a pericardial drain placed. Pericardial fluid cell count revealed hemorrhagic fluid with over 1 million RBC. Culture negative with no organisms seen. Autoimmune workup revealed a positive ANA with speckled pattern and furthermore ANCA screen significant for MPO antibody positive and PR3 antibody positive. Effusion secondary to trauma was less likely due to initial workup negative, and malignancy was not identified by pericardial fluid analysis. Patient was referred to rheumatology for initiation of immunosuppressive therapy to help prevent recurrence of the pericardial effusion. Discussion Pericardial effusion is an uncommon yet significant manifestation of eosinophilic granulomatosis with polyangiitis (EGPA). Prompt recognition and thorough evaluation of the underlying mechanism leading to pericardial effusion is important. Immunosuppressive therapy, particularly corticosteroids with or without additional agents, remain the mainstay of treatment in pericardial effusion secondary to EGPA-related inflammation. Identifying both the effusion and the underlying cause is essential for guiding appropriate therapy and improving clinical outcomes. This abstract is funded by: None
Carter et al. (Fri,) conducted a case report in Eosinophilic granulomatosis with polyangiitis (EGPA) with pericardial effusion (n=1). Pericardiocentesis and immunosuppressive therapy was evaluated. Emergent pericardiocentesis and subsequent immunosuppressive therapy successfully managed a 77-year-old male presenting with EGPA-related cardiac tamponade initially mimicking traumatic effusion.