LAUSR

In June 2017, a 50-year-old woman was admitted to our ward with fever, edema of the lower limbs, jugular turgor, fatigue, tachycardia, and dyspnea of 2 weeks duration. In the Emergency Department (ED), the patient was febrile (38 °C); the physical examination showed signs of right heart failure with tachycardia (110 bpm), hypotension (90/60 mmHg), and peripheral oxygen saturation 98%. A chest X-ray study revealed a left pleural effusion; blood examinations demonstrated increased values of C-reactive protein (CRP) 8.23 mg/dl (normal values < 0.5) and international normalized ratio (INR) was 1.44; echocardiogram showed minimum anterior pericardial effusion. The ECG was normal apart from nonspecific abnormalities of ST-T waves. Her medical history was significant for locally invasive uterine cervical squamous cell carcinoma (SCC) discovered in 2015, treated with chemotherapy and radiotherapy. Subsequent follow-up at 2 years (gynaecologic visit in April 2017) was negative for recurrence; the only altered examination was the SCC marker, elevated to 8 μg/l (previous 1.7 μg/dl). She was hospitalized 3 months prior for pleuropericarditis of unknown origin. During that hospitalization, she underwent echocardiography and cardiac magnetic resonance (MRI) that revealed a partially organized diffuse pericardial effusion with hematic appearance. Several other investigations were performed including ECG, thorax computed tomography (CT) scan with contrast medium targeted to pulmonary embolism, thoracentesis, blood culture, viral and bacterial serology, quantiferon-tuberculosis (quantiferon-TB), immunologic screening, and abdomen and thyroid ultrasound, without evidence of other acute alterations except for bilateral pleural effusions. She started a therapy with ibuprofen, colchicine, and bisoprolol, and she was discharged in April 2017.