A Rare Presentation of Subacute Constrictive Pericarditis Secondary to Rhinovirus Infection: A Case Report

TL;DR

A rare case of subacute constrictive pericarditis caused by rhinovirus infection is reported, highlighting the importance of considering uncommon viral causes in diagnosis.

Contribution

This case report identifies rhinovirus as a rare cause of subacute constrictive pericarditis and emphasizes the importance of thorough evaluation.

Findings

Rhinovirus infection can lead to subacute constrictive pericarditis in rare cases.

Early echocardiographic recognition and anti-inflammatory treatment can lead to complete resolution.

Exclusion of common causes is essential in diagnosing viral-induced constrictive pericarditis.

Abstract

Constrictive pericarditis is an uncommon but important complication of pericardial inflammation in which a stiff, scarred pericardium restricts normal ventricular filling. It is most often related to prior surgery, radiation, tuberculosis, or idiopathic causes, while viral causes rarely progress to constrictive physiology. Patients typically present with nonspecific symptoms such as shortness of breath and signs of right-sided heart failure, which can make diagnosis challenging. We describe a case of subacute constrictive pericarditis associated with rhinovirus infection after other common causes were excluded. This case highlights the need to consider uncommon viral etiologies and perform a thorough evaluation when assessing patients with suspected constrictive pericarditis.

The patient was a 49-year-old woman with no significant past medical history who presented with one month of pleuritic chest pain, progressive dyspnea, orthopnea, palpitations, and subjective fevers. Physical examination revealed tachycardia, muffled heart sounds, and a pericardial friction rub. Laboratory evaluation demonstrated markedly elevated inflammatory markers and an increased serum cardiac troponin level. CT of the chest showed a moderate pericardial effusion. Transthoracic echocardiography (TTE) revealed a circumferential organized pericardial effusion, exaggerated respiratory variation in mitral and tricuspid inflow velocities, annulus reversus, and septal bounce, findings compatible with early constrictive physiology. An extensive infectious and rheumatologic workup was unrevealing, with the exception of a positive rhinovirus polymerase chain reaction result. Treatment with nonsteroidal anti-inflammatory therapy, colchicine, and corticosteroids led to complete clinical and echocardiographic resolution.

Rhinovirus infection may, in rare instances, lead to subacute constrictive pericarditis. Early recognition through echocardiography and timely initiation of anti-inflammatory therapy may result in complete reversibility and reduce the risk of progression to chronic constrictive pericarditis that necessitates surgical intervention.

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