Coxsackie-B monarthritis with hepatitis. A case report

Effusive-constrictive pericarditis, hepatitis, and pancreatitis in a patient with possible coxsackievirus B infection: a case report

BACKGROUND

Coxsackie B is a viral pathogen that presents with various invasive diseases in adults. Historically, the majority of adult cases with pericarditis or myocarditis have been attributed to coxsackievirus B. The presentation of this viral infection causing effusive-constrictive pericarditis, hepatitis or pancreatitis is rare. This case report is the first to describe a patient with concomitant effusive-constrictive pericarditis, hepatitis and pancreatitis from possible coxsackievirus B infection.

CASE PRESENTATION

A 26-year old female was admitted to our hospital with the diagnosis of effusive-constrictive pericarditis complicated by tamponade and cardiac arrest. An emergent pericardiocentesis was performed successfully. Hepatitis and pancreatitis were also identified in our patient. After an extensive workup, coxsackievirus B infection was suspected by positive serum complement fixation antibody titers. Our patient made a full recovery and was discharged from the hospital.

CONCLUSION

Clinical suspicion of effusive-constrictive pericarditis with tamponade from coxsackievirus B should be considered in patients presenting with chest pain, dyspnea, jugular venous distention, hypotension, ST segment elevation on electrocardiogram, and ventricular interdependence with septal shift during diastole on transthoracic echocardiogram. Initial diagnoses of effusive-constrictive pericarditis resembling cardiac tamponade, hepatitis and pancreatitis can be challenging, and this case highlights the need for healthcare professionals to be cognizant of the association between these unusual clinical presentations and coxsackievirus B infection.

MR patterns of involvement of humeral head osteonecrosis

PURPOSE

To characterize osteonecrosis of the humeral head on coronal and axial MR images.

METHODS

We retrospectively reviewed MR examinations in patients with humeral head osteonecrosis. The angle of the entire affected articular surface at three levels was measured and an angle subtended by the margins of osteonecrosis was also measured.

RESULTS

The appearance of osteonecrosis is identical to that in the femoral head with signal abnormality (13/13), double-line sign (7/13), and subchondral fractures (3/13). The superior aspect of the humeral head was the most common location of osteonecrosis. The MR staging resulted as follows: stage II (6/13), stage IIIA (1/13), stage IIIB (1/13), and stage IV (5/13). The maximum percentage of involvement of the articular surface demonstrated the following distribution: 0% to 25%, 0/11; 25% to 50%, 1/13; 50% to 75%, 5/13; and 75% to 100%, 7/13.

CONCLUSIONS

Quantitative analysis of the percentage of involvement of the humeral head was performed and indicates that in most cases, 75% to 100% of the articular surface at the levels measured was involved.