A 58-year-old immunocompetent man with a history of peptic ulcer and orthostatic hypotension was referred for hospital admission by his cardiologist. Pleuritic chest pain, fever (maximum temperature 38.5°C), anorexia and pericardial effusion (12 mm) had begun a month previously. Given the suspicion of pericarditis, he was prescribed aspirin 1 g daily for six days, but without improvement. Initial assessment in the Emergency Department also revealed orthopnea, hypoxemia (pO2 59.5 mmHg; FiO2 0.21), bilateral pleural effusion (a lymphocyte-rich exudate), normocytic normochromic anemia (hemoglobin 115 g/l), C-reactive protein 19.2 mg/dl, and erythrocyte sedimentation rate 120 mm/h. The ECG showed sinus rhythm and nonspecific repolarization changes. He was admitted for further investigation, and oxygen therapy and respiratory physiotherapy were begun, as well as paracetamol for temperatures over 38°C. Two days later repeat echocardiography showed a spiderweb appearance of the pericardium, formed by side-to-side connections of fibrin strands (Figure 1). Pericardiocentesis with biopsy was performed, revealing an inflammatory infiltrate with fibrin (Figure 2). Serological studies revealed a parvovirus B19 infection: IgM 6.04 UA/ml (normal <1.0) and IgG 4.41 UA/ml (normal <1.0). All other serological studies, blood, urine and pleural effusion cultures, and requested autoimmunity markers were negative. The patient was discharged 28 days after admission following remission of clinical symptoms and normalization of imaging and laboratory parameters. Three years later, he has no oncological, autoimmune or infectious disease.

Figure 1.

Organized pericardial fibrin network. Apical 4-chamber echocardiographic view (A) and angular rotation from apical view to apex (B).

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Figure 2.

Histological samples. (A) Fibrinous pericarditis (hematoxylin-eosin ×100); (B) bloody pericardial effusion, with no signs of malignity (hematoxylin-eosin ×100); (C) hyperplastic mesothelial cells (calretinin ×100); (D) inflammatory infiltrate with numerous macrophages (CD68 ×100).

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Infection by parvovirus B19 is common. Most adults with parvovirus B19 infection are asymptomatic. Although it is a well-known cause of pericarditis, severe situations like the one presented are rare in patients with no type of immunodeficiency.