Campylobacter and Pericarditis in the Setting of Common Variable Immunodeficiency: A Case Report

1Dartmouth‐Hitchcock Medical Center, Lebanon, NH
2Dartmouth‐Hitchcock Medical Center, Lebanon, NH

Meeting: Hospital Medicine 2013, May 16-19, National Harbor, Md.

Abstract number: 447

Case Presentation:

A 46‐year‐old man presented with a weeklong history of abdominal cramps and sharp, substernal chest pain, with associated fevers up to 39.4°C, chills, and fatigue. On presentation, a CT of the abdomen and pelvis was notable only for small bilateral pleural effusions. He was given pain medication and discharged home. Given his history of Campylobacter infection 9 years ago in concert with abdominal discomfort despite a lack of diarrhea, stool studies had been obtained and returned positive for Campylobacter. The results were relayed to his primary care provider and he was treated with a 5‐day course of azithromycin. He transiently improved on the antibiotics. However, the chest pain and fatigue became worse and he was found in his bathroom shivering and unresponsive to questioning. On repeat presentation to the hospital, a CT of the chest, abdomen and pelvis revealed a pericardial effusion. He developed atrial fibrillation with rapid ventricular response, hypotension and tachycardia. After returning to sinus rhythm, his EKG did not reveal ischemic changes and his cardiac biomarkers were negative. A transthoracic echocardiogram showed a moderate circumferential pericardial effusion (1.4 cm anteriorly and 1.7 cm posteriorly) with mild exaggeration of the respiratory variation in mitral inflow peak velocities, no tamponade physiology, and no wall motion abnormalities. Pericardiocentesis was performed and the fluid analysis revealed: 22,755 nucleated cells (Neutrophils 96%, Lymphocytes 1%, Macrophages 5%), a lactate dehydrogenase of 363, and negative cultures. He was started on high‐dose nonsteroidal anti inflammatory medication and colchicine for treatment of his pericarditis. Over the next few days he had recurrent brief episodes of atrial fibrillation and was intermittently febrile without a clear source. Evaluation for other causes of his pericarditis, including a serum protein electrophoresis, revealed hypogammaglobulinemia (IgG 4.78 g/L, IgM 0.19 g/L, IgA 1.25 g/L) and the diagnosis of common variable immunodeficiency (CVID) was made. He was treated with an infusion of intravenous immunoglobulin after which he remained afebrile and a repeat echocardiogram prior to discharge revealed no evidence of pericardial effusion.

Discussion:

The association of Campylobacter infection with the development of pericarditis has been well established in the literature. Most cases are of young males and most follow a benign course. However, most cases are associated with elevated cardiac biomarkers and EKG changes. In this case, it is suspected that the patient's underlying CVID led to repeated Campylobacter infections (or a lack of clearance of an initial infection) and that the Campylobacter infection led to the pericarditis and pericardial effusion.

Conclusions:

The purpose of reporting this case is to increase general awareness of this rare complication of Campylobacter infection.

To cite this abstract:

Hill E, Liu S. Campylobacter and Pericarditis in the Setting of Common Variable Immunodeficiency: A Case Report. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 447. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/campylobacter-and-pericarditis-in-the-setting-of-common-variable-immunodeficiency-a-case-report/. Accessed September 18, 2019.

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