HIV induced pericarditis differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ramyar Ghandriz MD[2]

Overview

HIV pericarditis must be differentiated based on existence of pericarditis and reason of pericarditis, so the below is the differential according to these two different basis.

Differentiating HIV induced pericarditis from other Diseases

  • HIV induced pericarditis usually remains sillent and is found during autopsies as a random co-existing condition.
  • If it was symptomatic, we can differentiate underlying cause as below:
Diseases Clinical manifestations Para-clinical findings Gold standard
Symptoms Physical examination
Lab Findings Histopathology and imaging
Chest pain Jugular vein Dry cough with hemoptesis Friction rub Lymph-adenopathy Sputom cuture Histological demonestration
Tuberculosis + elevated If +, increases the risk + +/- + - Active caseating granuloma in lungs Treat all HIV induced pericarditis for tuberclosis. if not clinically improved, search for other diseases.
Congestive cardiomypathy + not elevated - - - - - Causes detectable CXR changes.
pneumocystis + + - + - + - Detectable by unique shape and pathologic features
CMV + + - + + - + Detecting pathologic giant CD8+ T-cell
Kaposi sarcoma + + - + + - + Specific skin and GI manifestations
Lymphoma + + - + + - + Lymph node excision and frozen section manifest unique features

Differential diagnosis of pericarditis

Chest pain or pressure are common symptoms. A small effusion may be asymptomatic. Larger effusions may cause cardiac tamponade, a life-threatening complication and the signs of impending tamponade include dyspnea, low blood pressure, and distant heart sounds. There are several other cardiac insults with similar symptoms that should be considered in differential diagnosis of pericardial effusion.

Differential Diagnosis by Organ System

Cardiovascular Cathether ablation for arrhythmias, coronary artery bypass grafting, dissecting aortic aneurysm, Dresslers syndrome, endocarditis, myocarditis, pacemaker insertion, percutaneous coronary intervention, postpericardiotomy syndrome, TAVI, thoracic surgery, valvuloplasty
Chemical / poisoning Silicosis
Dermatologic Behcet syndrome[1]
Drug Side Effect Dantrolene, doxorubicin, hydralazine, isoniazid, penicillin, phenylbutazone, procainamide
Ear Nose Throat Temporal arteritis[2]
Endocrine Addisonian crisis, Severe hypothyroidism (myxedema)
Environmental No underlying causes
Gastroenterologic Inflammatory bowel disease, Whipple's
Genetic Gaucher disease, Jacobs arthropathy-camptodactyly syndrome, Mulibrey nanism syndrome, recurrent hereditary polyserositis
Hematologic Leukemia, lymphoma
Iatrogenic Cardiopulmonary resuscitation, postpericardiotomy syndrome, radiation therapy, serum sickness, thoracic duct obstruction secondary to tumor, surgery
Infectious Disease Actinomycosis, adenovirus, alveolar hydatid disease, amebiasis, aspergillus, blastomycosis, borrelia, brucellosis, candida, coccidiomycosis, coxsackie B virus, cytomegalovirus, Ebstein-Barr virus, echinococcus, echovirus, entamoeba histolytica, escherichia coli, francisella, haemophilus influenza, hepatitis B, histoplasmosis, influenza, klebsiella, legionella, Lyme disease, meningococci, mumps, mycoplasma pnuemonia, neisseria, nocardia, pneumococcus, proteus, pseudomonas, rickettsia, salmonella, staphylococcus, streptococcus, toxoplasmosis, tuberculous, tularemia, varicella
Musculoskeletal / Ortho No underlying causes
Neurologic No underlying causes
Nutritional / Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic Breast cancer, carcinoid, fibroma, kaposis sarcoma, leukemia, lipoma, lung cancer, lymphomas, melanoma, mesothelioma, ovarian cancer, sarcoma, Sipple syndrome
Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary Sarcoidosis
Renal / Electrolyte Uremia
Rheum / Immune / Allergy Acute rheumatic fever, amyloidosis, ankylosing spondylitis, Behcet syndrome, Kawasaki disease, mixed connective tissue disease, polyarteritis nodosa, polymyositis, Reiter's Syndrome, rheumatoid arthritis, sarcoidosis, scleroderma, Still's disease, systemic lupus erythematosus, systemic sclerosis, temporal arteritis, Wegener's
Sexual Neisseria gonorrhoeae[3], treponema pallidum
Trauma Blunt or penetrating chest trauma, esophageal rupture, esophogeal perforation, gastric perforation, pancreatic-pericardial fistula
Urologic Renal Failure, uremia
Miscellaneous Idiopathic

References

  1. Scarlett JA, Kistner ML, Yang LC (1979). "Behçet's syndrome. Report of a case associated with pericardial effusion and cryoglobulinemia treated with indomethacin". Am J Med. 66 (1): 146–8. PMID 420242.
  2. Garewal HS, Uhlmann RF, Bennett RM (1981). "Pericardial effusion in association with giant cell arteritis". West J Med. 134 (1): 71–2. PMC 1272467. PMID 7210667.
  3. Wilson J, Zaman AG, Simmons AV (1990). "Gonococcal arthritis complicated by acute pericarditis and pericardial effusion". Br Heart J. 63 (2): 134–5. PMC 1024342. PMID 2317408.