Hydropneumopericardium: A Rare Complication of an Oesophageal Tumour.

Hydropneumopericardium is a rare event with a risk of serious complications. Timely diagnosis and treatment is important as it can improve prognosis. We report the case of a 77-year-old male patient who presented with acute interscapular pain which developed during a meal. An oesophago-pericardial fistula was found in the context of malignant oesophageal disease. LEARNING POINTS: Hydropneumopericardium secondary to oesophageal tumour is a rare but life-threatening finding that has a very poor prognosis.A high level of suspicion is needed, as the clinical manifestations are very unspecific and timely treatment can improve prognosis.Successful management of an oesophago-pericardial fistula includes surgical treatment and antibiotic therapy.

Fulminant Haemolysis Following Endoscopic Retrograde Cholangiopancreatography.

We report the case of a 77-year-old-man with a history of type 2 diabetes mellitus who underwent endoscopic retrograde cholangiopancreatography (ERCP) because of a gallstone in the common bile duct. Thirty-six hours after the procedure, the patient developed persistent fever and epigastric pain associated with de novo jaundice. Massive haemolysis (with exuberant spherocytosis) occurred and patient died in 3 hours. Clostridium perfringens was isolated in the blood cultures. Massive haemolysis associated with C. perfringens has a high mortality rate. Management involves a high index of suspicion after gastrointestinal procedures like ERCP, surgical consultation, antibiotic therapy, transfusion of red cell concentrates and, potentially, hyperbaric oxygen therapy. LEARNING POINTS: Endoscopic retrograde cholangiopancreatography (ERCP) can be complicated by Clostridium perfringens bacteraemia with devastating consequences.C. perfringens infection should be suspected in an icteric, febrile patient with abdominal pain, especially if intravascular haemolysis is present.Management of intravascular haemolysis and inflammation in a patient following ERCP should be multidisciplinary, involving surgery when needed and potentially hyperbaric oxygen therapy; penicillin or penicillin-derived antibiotics associated with clindamycin or metronidazole are the mainstays of antibiotic therapy.

Bilateral dacryoadenitis as initial presentation of a locally aggressive and unresponsive limited form of orbital granulomatosis with polyangiitis.

Limited orbital granulomatosis with polyangiitis (GPA) is uncommon and its diagnosis may be delayed, especially when isolated lacrimal involvement is the initial presentation, because clinical manifestations are non-specific and systemic diagnostic criteria are not applicable. Making an early diagnosis despite the absence of systemic progression is extremely important because in some cases the disease is locally destructive, with irreversible visual and functional loss, and it can be refractory to corticosteroids and conventional immunosuppressive drugs to induce remission. The authors report an unusual limited form of orbital GPA in a 35-year-old woman presenting with bilateral dacryoadenitis, evolving later to locally aggressive bilateral orbital pseudotumour leading to proptosis, extraocular myositis, diplopia and medial deviation of the nasal septum. She had never had systemic manifestations but her disease was persistently active and unresponsive to corticosteroids and immunosuppressors. The aim of this paper is to provide further evidence of aggressive and refractory limited forms of GPA.

Isolated pulmonary valve endocarditis due to Pseudomonas aeruginosa.

Isolated endocarditis of the native pulmonary valve is a rare clinical condition. It usually appears in association with certain predisposing factors, particularly intravenous drug abuse, alcohol abuse, sepsis, endovascular infections or congenital heart disease. The authors describe the case of isolated pulmonary valve endocarditis due to Pseudomonas aeruginosa of possible nosocomial origin in the absence of the predisposing factors mentioned above. Native pulmonary valve infection due to Pseudomnzonas aeruginosa in the absence of predisposing factors has not been described in the literature. The authors stress the importance of diagnosing this entity as early as possible as it is associated with high mortality and is on the increase due to the growing number of invasive procedures applied to patients in the hospital environment.

Constrictive pericarditis of tuberculous etiology in the HIV-positive patient: case report and review of the literature.

Pericardial inflammation secondary to Mycobacterium tuberculosis infection is a rare condition, but its incidence is increasing in parallel with human immunodeficiency virus infection. Recrudescence of various types of tuberculosis should alert the clinician to the possibility of tuberculous pericarditis. The authors present the case of a 27-year-old white male, seropositive for the human immunodeficiency virus, presenting with large volume pericardial effusion and unusual echocardiographic features, global heart failure and clinical suspicion of tuberculosis. After anti-tuberculous chemotherapy and systemic corticosteroids there was some clinical improvement but evolution to constriction. The patient underwent pericardiectomy with good results. The authors present a literature review on constrictive tuberculous pericarditis in human immunodeficiency virus seropositive and seronegative patients, discussing the role of corticosteroids and the contribution of different diagnostic tools.