26175648 Visualization

In March Date 2009 Date , a 21 Age - year Age - old Age man Sex was admitted Activity to another Nonbiological_location institution Nonbiological_location with symptoms of intermittent Frequency fever Sign_symptom , headache Sign_symptom , polyarthralgias Sign_symptom , skin Biological_structure rash Sign_symptom over the trunk Biological_structure , and petechiae Sign_symptom in the fingers Biological_structure and palms Biological_structure .
The patient was previously History healthy History , had no History history History of History drug History abuse History , and took no History regular History medication History .
He also had no History pets History and had History not History traveled History recently History .
He had been in his usual state of health until one Date month Date before Date admission Activity , when intermittent Detailed_description high Severity fever Sign_symptom developed ( maximum Diagnostic_procedure axillary Diagnostic_procedure temperature Diagnostic_procedure , >39 Quantitative_concept °C Quantitative_concept ).
In addition, he reported headaches Sign_symptom , bilateral Detailed_description and symmetric Detailed_description arthralgia Sign_symptom on the wrists Biological_structure and hands Biological_structure (with an inflammatory Detailed_description pattern Detailed_description ), petechiae Sign_symptom over the palms Biological_structure and fingers Biological_structure , salmon Color - colored Color rash Sign_symptom on the trunk Biological_structure , nausea Sign_symptom , and vomiting Sign_symptom .
An evanescent Detailed_description , salmon Color - colored Color rash Sign_symptom was observed on his chest Biological_structure and abdomen Biological_structure , and 2 Distance - mm Distance petechiae Sign_symptom covered the palms Biological_structure and the fingers Biological_structure .
No signs suggested arthritis Disease_disorder , and there was no lymphadenopathy Sign_symptom or hepatosplenomegaly Sign_symptom .
Blood Diagnostic_procedure testing Diagnostic_procedure showed elevated Qualitative_concept inflammatory Diagnostic_procedure markers Diagnostic_procedure (Table II).
The electrocardiographic Diagnostic_procedure ( ECG Diagnostic_procedure ) and chest Biological_structure radiographic Diagnostic_procedure results were normal Lab_value .
Ibuprofen Medication ( 1,200 Dosage mg/d Dosage ) and acetaminophen Medication ( as Dosage needed Dosage ) were begun and provided symptomatic Sign_symptom relief.
An extensive evaluation Diagnostic_procedure was performed, including blood Diagnostic_procedure cultures Diagnostic_procedure , viral Detailed_description and Detailed_description bacterial Detailed_description serologic Diagnostic_procedure studies Diagnostic_procedure , immunologic Diagnostic_procedure screening Diagnostic_procedure ( rheumatoid Diagnostic_procedure factor Diagnostic_procedure and antinuclear Diagnostic_procedure antibodies Diagnostic_procedure ), and computed Diagnostic_procedure tomographic Diagnostic_procedure ( CT Diagnostic_procedure ) studies of the chest Biological_structure , abdomen Biological_structure , pelvis Biological_structure , and cranium Biological_structure .
No Lab_value significant Lab_value changes Lab_value were found.
However, a transthoracic Diagnostic_procedure echocardiogram Diagnostic_procedure ( TTE Diagnostic_procedure ) showed circumferential Detailed_description , mild Severity pericardial Sign_symptom effusion Sign_symptom ( maximal Diagnostic_procedure diameter Diagnostic_procedure , 8 Lab_value mm Lab_value ), with no signs of tamponade Sign_symptom or other relevant findings.
A Date few Date days Date later Date , dyspnea Sign_symptom and diffuse Detailed_description chest Biological_structure pain Sign_symptom developed.
The pain Sign_symptom was relieved by chest Biological_structure anteflexion Activity and aggravated by deep Detailed_description inspiration Activity and by lying Activity supine Activity .
The patient was hypotensive Sign_symptom , tachycardic Sign_symptom , and hyperpneic Sign_symptom , and he manifested jugular Biological_structure venous Biological_structure distention Sign_symptom .
The ECG Diagnostic_procedure showed sinus Detailed_description tachycardia Sign_symptom and diffuse Detailed_description ST Sign_symptom - segment Sign_symptom elevation Sign_symptom (Fig.1), the chest Biological_structure radiograph Diagnostic_procedure revealed an enlarged Sign_symptom cardiac Biological_structure silhouette (Fig.2), and the inflammatory Diagnostic_procedure markers Diagnostic_procedure were again elevated Lab_value (Table II).
A repeat TTE Diagnostic_procedure showed an increase in the pericardial Sign_symptom effusion Sign_symptom (maximal diameter, 12 Distance mm Distance ) (Fig.3) and collapse Sign_symptom of the right Biological_structure heart Biological_structure chambers Biological_structure .
Emergency Detailed_description pericardiocentesis Therapeutic_procedure drained 60 Volume mL Volume of serosanguineous Sign_symptom fluid Sign_symptom .
When repeated, CT Diagnostic_procedure of the chest Biological_structure and abdomen Biological_structure revealed mild Severity right Detailed_description and severe Severity left Detailed_description pleural Sign_symptom effusion Sign_symptom , as well as mild Severity ascites Sign_symptom .
Thoracocentesis Therapeutic_procedure was then performed, during which 350 Volume mL Volume of serosanguineous Sign_symptom pleural Sign_symptom fluid Sign_symptom was drained.
Both heart Biological_structure and lung Biological_structure fluids Detailed_description were exudates that yielded negative Lab_value microbiologic Diagnostic_procedure examination Diagnostic_procedure and were unremarkable Lab_value upon histologic Diagnostic_procedure analysis Diagnostic_procedure .
The diagnosis of AOSD Disease_disorder was established, and the patient was medicated Medication with prednisone Medication ( 0.5 Dosage mg/kg/d Dosage ), with major clinical Detailed_description and laboratory Detailed_description improvement Sign_symptom (Table II).
There was also ST Sign_symptom - segment Sign_symptom normalization Sign_symptom , and the follow-up echocardiogram Diagnostic_procedure showed only mild Severity pericardial Sign_symptom effusion Sign_symptom (2–3 mm Distance ), without hemodynamic Disease_disorder compromise Disease_disorder .
Screening Diagnostic_procedure for autoimmune Detailed_description and infectious Detailed_description disorders Disease_disorder was repeated, and no Lab_value significant Lab_value changes Lab_value were found.
The patient was discharged Activity from the hospital Nonbiological_location on a regimen of prednisone Medication .
There was a recurrence of pericardial Detailed_description and pleural Detailed_description effusion Sign_symptom 2 Date months Date after Date discharge Clinical_event (after corticosteroid Medication weaning and withdrawal), which was resolved by resuming the prednisone Medication therapy.
Ten Date months Date after Date discharge, the patient presented Activity at our institution Nonbiological_location for a follow Activity - up Activity visit Activity .
He was asymptomatic Outcome and was maintained on corticosteroid Medication therapy.
Follow-up ECG Diagnostic_procedure and TTE Diagnostic_procedure showed no Lab_value significant Lab_value changes Lab_value (Figs.4 and ​5).