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Chlamydia pneumoniae-associated pleuropericarditis: a case report and systematic review of the literature
BACKGROUND: Chlamydia pneumoniae is a common cause of atypical community acquired pneumonia (CAP). The diagnostic approach of chlamydial infections remains a challenge. Diagnosis of delayed chlamydial-associated complications, involving complex autoimmune pathophysiological mechanisms, is still more...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8607726/ https://www.ncbi.nlm.nih.gov/pubmed/34809625 http://dx.doi.org/10.1186/s12890-021-01743-9 |
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author | Kyriakoulis, Konstantinos G. Kollias, Anastasios Diakos, George E. Trontzas, Ioannis P. Fyta, Eleni Syrigos, Nikolaos K. Poulakou, Garyphallia |
author_facet | Kyriakoulis, Konstantinos G. Kollias, Anastasios Diakos, George E. Trontzas, Ioannis P. Fyta, Eleni Syrigos, Nikolaos K. Poulakou, Garyphallia |
author_sort | Kyriakoulis, Konstantinos G. |
collection | PubMed |
description | BACKGROUND: Chlamydia pneumoniae is a common cause of atypical community acquired pneumonia (CAP). The diagnostic approach of chlamydial infections remains a challenge. Diagnosis of delayed chlamydial-associated complications, involving complex autoimmune pathophysiological mechanisms, is still more challenging. C. pneumoniae-related cardiac complications have been rarely reported, including cases of endocarditis, myocarditis and pericarditis. CASE PRESENTATION: A 40-year old female was hospitalized for pleuropericarditis following lower respiratory tract infection. The patient had been hospitalized for CAP (fever, dyspnea, chest X-ray positive for consolidation on the left upper lobe) 5 weeks ago and had received ceftriaxone and moxifloxacin. Four weeks after her discharge, the patient presented with fever, shortness of breath and pleuritic chest pain and was readmitted because of pericardial and bilateral pleural effusions (mainly left). The patient did not improve on antibiotics and sequential introduction of colchicine and methylprednisolone was performed. The patient presented impressive clinical and laboratory response. Several laboratory and clinical assessments failed to demonstrate any etiological factor for serositis. Chlamydial IgM and IgG antibodies were positive and serial measurements showed increasing kinetics for IgG. Gold standard polymerase chain reaction of respiratory tract samples was not feasible but possibly would not have provided any additional information since CAP occurred 5 weeks ago. The patient was discharged under colchicine and tapered methylprednisolone course. During regular clinic visits, she remained in good clinical condition without pericardial and pleural effusions relapse. CONCLUSIONS: C. pneumoniae should be considered as possible pathogen in case of pleuritis and/or pericarditis during or after a lower respiratory tract infection. In a systematic review of the literature only five cases of C. pneumoniae associated pericarditis were identified. Exact mechanisms of cardiovascular damage have not yet been defined, yet autoimmune pathways might be implicated. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12890-021-01743-9. |
format | Online Article Text |
id | pubmed-8607726 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-86077262021-11-22 Chlamydia pneumoniae-associated pleuropericarditis: a case report and systematic review of the literature Kyriakoulis, Konstantinos G. Kollias, Anastasios Diakos, George E. Trontzas, Ioannis P. Fyta, Eleni Syrigos, Nikolaos K. Poulakou, Garyphallia BMC Pulm Med Case Report BACKGROUND: Chlamydia pneumoniae is a common cause of atypical community acquired pneumonia (CAP). The diagnostic approach of chlamydial infections remains a challenge. Diagnosis of delayed chlamydial-associated complications, involving complex autoimmune pathophysiological mechanisms, is still more challenging. C. pneumoniae-related cardiac complications have been rarely reported, including cases of endocarditis, myocarditis and pericarditis. CASE PRESENTATION: A 40-year old female was hospitalized for pleuropericarditis following lower respiratory tract infection. The patient had been hospitalized for CAP (fever, dyspnea, chest X-ray positive for consolidation on the left upper lobe) 5 weeks ago and had received ceftriaxone and moxifloxacin. Four weeks after her discharge, the patient presented with fever, shortness of breath and pleuritic chest pain and was readmitted because of pericardial and bilateral pleural effusions (mainly left). The patient did not improve on antibiotics and sequential introduction of colchicine and methylprednisolone was performed. The patient presented impressive clinical and laboratory response. Several laboratory and clinical assessments failed to demonstrate any etiological factor for serositis. Chlamydial IgM and IgG antibodies were positive and serial measurements showed increasing kinetics for IgG. Gold standard polymerase chain reaction of respiratory tract samples was not feasible but possibly would not have provided any additional information since CAP occurred 5 weeks ago. The patient was discharged under colchicine and tapered methylprednisolone course. During regular clinic visits, she remained in good clinical condition without pericardial and pleural effusions relapse. CONCLUSIONS: C. pneumoniae should be considered as possible pathogen in case of pleuritis and/or pericarditis during or after a lower respiratory tract infection. In a systematic review of the literature only five cases of C. pneumoniae associated pericarditis were identified. Exact mechanisms of cardiovascular damage have not yet been defined, yet autoimmune pathways might be implicated. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12890-021-01743-9. BioMed Central 2021-11-22 /pmc/articles/PMC8607726/ /pubmed/34809625 http://dx.doi.org/10.1186/s12890-021-01743-9 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Case Report Kyriakoulis, Konstantinos G. Kollias, Anastasios Diakos, George E. Trontzas, Ioannis P. Fyta, Eleni Syrigos, Nikolaos K. Poulakou, Garyphallia Chlamydia pneumoniae-associated pleuropericarditis: a case report and systematic review of the literature |
title | Chlamydia pneumoniae-associated pleuropericarditis: a case report and systematic review of the literature |
title_full | Chlamydia pneumoniae-associated pleuropericarditis: a case report and systematic review of the literature |
title_fullStr | Chlamydia pneumoniae-associated pleuropericarditis: a case report and systematic review of the literature |
title_full_unstemmed | Chlamydia pneumoniae-associated pleuropericarditis: a case report and systematic review of the literature |
title_short | Chlamydia pneumoniae-associated pleuropericarditis: a case report and systematic review of the literature |
title_sort | chlamydia pneumoniae-associated pleuropericarditis: a case report and systematic review of the literature |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8607726/ https://www.ncbi.nlm.nih.gov/pubmed/34809625 http://dx.doi.org/10.1186/s12890-021-01743-9 |
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