A 52-year-old woman presents to the emergency department with complaints of shortness of breath and a sharp pain that radiates to her neck area each time she takes a breath. She reports that she feels more comfortable when sitting and leaning forward. An ECG reveals no acute changes. Physical examination reveals that the lungs are clear to auscultation, and there is a friction rub heard on cardiac examination. A chest x-ray is negative, and an electrocardiogram reveals no acute changes. An echocardiogram reveals a moderate pericardial effusion.
Which of the following is most likely causative agents of the patient's symptoms?
A) Coxsackie virus
B) Mycobacterium tuberculosis
C) Parvovirus B19
D) Staphylococcus aureus
E) Streptococcus viridans
A) Coxsackie virus
Based on the clinical presentation the patient likely has pericarditis. The major clinical manifestations include chest pain, pericardial friction rub, ECG changes (widespread ST elevation or PR depression) and pericardial effusion. In developed countries, most cases of acute pericarditis are considered to be of viral origin. The most common viral infections causing pericarditis are reported to be Coxsackie virus and echovirus. Mycobacterium tuberculosis can cause pericarditis but is much less common than viral etiologies, and this patient does not have stated risk factors for TB. Parvovirus B19 is associated with erythema infectiosum (Fifth disease). Staphylococcus aureus and Streptococcus viridans can cause infective endocarditis.
Key Learning Point
Most cases of acute pericarditis are considered to be of viral origin.
