Post-operative Constrictive Pericarditis Complicated with Lymphocytopenia and Hypoglobulinemia

Masaki OHSAWA; Motoyuki NAKAMURA; Li-hua PAN; Takehito SHIZUKA; Jun-ichi NAKAGAWA; Hirobumi ISHIDA; Mami OUCHI; Takahiro SHIROTO; Kazuhiko HOTTA; Takashi SAWAI; Katsuhiko HIRAMORI

doi:10.2169/internalmedicine.43.811

Cardiovascular Diseases

Post-operative Constrictive Pericarditis Complicated with Lymphocytopenia and Hypoglobulinemia

Masaki OHSAWA, Motoyuki NAKAMURA, Li-hua PAN, Takehito SHIZUKA, Jun-ichi NAKAGAWA, Hirobumi ISHIDA, Mami OUCHI, Takahiro SHIROTO, Kazuhiko HOTTA, Takashi SAWAI, Katsuhiko HIRAMORI

Author information

Masaki OHSAWA
Second Department of Internal Medicine, Iwate Medical University
Motoyuki NAKAMURA
Second Department of Internal Medicine, Iwate Medical University
Li-hua PAN
First Department of Pathology, Iwate Medical University
Takehito SHIZUKA
Second Department of Internal Medicine, Iwate Medical University
Jun-ichi NAKAGAWA
Second Department of Internal Medicine, Iwate Medical University
Hirobumi ISHIDA
Second Department of Internal Medicine, Iwate Medical University
Mami OUCHI
Second Department of Internal Medicine, Iwate Medical University
Takahiro SHIROTO
Second Department of Internal Medicine, Iwate Medical University
Kazuhiko HOTTA
Second Department of Internal Medicine, Iwate Medical University
Takashi SAWAI
First Department of Pathology, Iwate Medical University
Katsuhiko HIRAMORI
Second Department of Internal Medicine, Iwate Medical University

Keywords: constrictive pericarditis, protein-losing enteropathy, lymphocytopenia, cellulitis, septicemia, cardiac surgery

JOURNAL OPEN ACCESS

2004 Volume 43 Issue 9 Pages 811-815

DOI https://doi.org/10.2169/internalmedicine.43.811

Details

Abstract

A 71-year-old man who had a history of open chest surgery was admitted due to anasarca and bilateral pleural effusions. Although imaging modalities could not demonstrate any pericardial abnormalities, right-sided cardiac catheterization revealed ‘dip and plateau’ in diastolic pressure waveform. He was admitted frequently because of the episodic right-sided congestive heart failure and hypoproteinemia due to protein-losing enteropathy. The peripheral lymphocyte count and serum gamma-globulin concentration were gradually decreased, and finally showed lymphocytopenia and hypoglobulinemia. On the last admission, the patient showed extensive cellulitis on both legs, and he developed septicemia, and finally died due to septic shock. Post-mortem examination showed that both visceral and parietal layers of the pericardium adhered tightly with mediastinal fibrosis. This case report suggested that constrictive pericarditis should be considered even if there is a lack of typical abnormal pericardial imaging findings when patients have a history of open chest surgery and recurrent rightsided congestive heart failure. In addition, we should be aware of a serious outcome due to immune compromised conditions such as lymphocytopenia and dysglobulinemia in this disorder.

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