Hemopericardio, taponamiento cardíaco, y absceso hepático en un varón joven

Abstract

Este artículo puede ser consultado en versión completa en http://www.medigraphic.com/neumologia ABSTRACT. A previously healthy 18-year-old man was admitted with asthenia, fever, shivering, oppressive chest pain, and orthopnea of three-day duration. He had an infected finger wound and lymphangitis on his forearm, self-medicated with topical ointments unsuccessfully. He was febrile (39 o C), hypotensive, with low SpO 2 and oliguria, without peripheral edema, hepatojugular reflux or pericardial friction rub. He suddenly had jugular distention, muffled heart sounds and paradoxical pulse, indicating cardiac tamponade, further confirmed. Erythrocyte sedimentation rate, neutrophil-lymphocyte count ratio, C-reactive protein, and procalcitonin) were elevated. Despite of intensive care he had irreversible cardiac arrest. Autopsy revealed hemopericardium causing death by cardiac tamponade and pulmonary edema, in addition to fibrinous pericarditis, hepatic abscess, and acute tubular necrosis. Methicillin-resistant Staphylococcus aureus (MRSA) was found in tissue and blood samples. Eventual tuberculosis coinfection and pericardial involvement by malignancy were ruled out. The role of autopsy to better understand mechanisms of cardiac tamponade is commented.