Cardiac tamponade due to post–cardiac injury syndrome in a patient with severe haemophilia A and HIV‐1 infection

Abstract

An 18-year-old man with severe haemophilia A (FVIII:C < 1%) and human immunodeficiency virus 1 (HIV-1) infection was admitted to the hospital with fever and chest pain for 7 days. Eight weeks prior to his admission he had an accident for which he underwent, at another hospital, clinical and laboratory examination that revealed bone fractures of the nose cavity, and he was given factor VIII concentrates for seven days due to nasal bleeding. On admission, chest roentgenogram showed a large cardiac silhouette and echocardiography confirmed the presence of a large quantity of pericardial fluid. A presumptive diagnosis of the post-cardiac injury syndrome was made and he was given anti-inflammatory drugs plus infusion of recombinant factor VIII concentrate (35 units kg-1 b.i.d.). On the seventh day he exhibited cardiac tamponade for which he underwent subxiphoid pericardiotomy with drainage of approximately 1500 mL of bloody exudate. He had an uncomplicated recovery and 10 days later he left hospital. He was given a continuous prophylactic treatment of 15 units kg-1 of recombinant FVIII every 2 days for 6 months, and 30 months after this episode the patient is free of any symptom.

Pericardial effusion of HIV-infected patients - results of a prospective multicenter cohort study in the era of antiretroviral therapy

“…Also other previously described reasons like neoplasm or a cardiac trauma [17-20] could be ruled out in our patients. One patient presented with liver cirrhosis based on hepatitis infection and renal disorder which lead to the suggestion that these diseases were responsible for development of pericardial effusion rather than the HIV-Infection.…”

Comorbidity of Constrictive Pericarditis and Hemophilia A

“…There is 1 case in the literature reporting HIV virus infection with postcardiac injury, a cardiac tamponade drained surgically [7] . That particular case was also signifi cant for the benefi cial effects of anti-infl ammatory agents, aspirin and prophylactic factor VIII infusions.…”

“…The defi nitive treatment of CP is pericardiectomy, but at the early stage (functional class 1) or advanced stage (functional class 4), which is a high-risk surgical condition, surgery may not be life-saving [6] . Comorbidity with hemophilia A is also a life-threatening medical problem because of its complications, which include hemorrhage into the skin, muscles, mucous membranes (e.g., epistaxis, gastrointestinal and urological bleeds), retroperitoneal hematoma, prolonged postpartum bleeding, cerebral hemorrhage and excessive bleeding following trauma and intraoperative as well as postoperative bleeding [7,8] . We report a case of comorbidity of hemophilia A and CP, treated medically.…”