Chlamydia pneumoniae-associated pleuropericarditis: a case report and systematic review of the literature

Abstract 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 st...

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Autores principales:	Konstantinos G. Kyriakoulis, Anastasios Kollias, George E. Diakos, Ioannis P. Trontzas, Eleni Fyta, Nikolaos K. Syrigos, Garyphallia Poulakou
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Pericarditis Pleuritis Pleuropericarditis Serositis Chlamydia pneumonia Community acquired pneumonia Diseases of the respiratory system RC705-779
Acceso en línea:	https://doaj.org/article/af2644c69b104dd8acd9ba701ad7d215
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spelling	oai:doaj.org-article:af2644c69b104dd8acd9ba701ad7d2152021-11-28T12:36:20ZChlamydia pneumoniae-associated pleuropericarditis: a case report and systematic review of the literature10.1186/s12890-021-01743-91471-2466https://doaj.org/article/af2644c69b104dd8acd9ba701ad7d2152021-11-01T00:00:00Zhttps://doi.org/10.1186/s12890-021-01743-9https://doaj.org/toc/1471-2466Abstract 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.Konstantinos G. KyriakoulisAnastasios KolliasGeorge E. DiakosIoannis P. TrontzasEleni FytaNikolaos K. SyrigosGaryphallia PoulakouBMCarticlePericarditisPleuritisPleuropericarditisSerositisChlamydia pneumoniaCommunity acquired pneumoniaDiseases of the respiratory systemRC705-779ENBMC Pulmonary Medicine, Vol 21, Iss 1, Pp 1-8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Pericarditis Pleuritis Pleuropericarditis Serositis Chlamydia pneumonia Community acquired pneumonia Diseases of the respiratory system RC705-779
spellingShingle	Pericarditis Pleuritis Pleuropericarditis Serositis Chlamydia pneumonia Community acquired pneumonia Diseases of the respiratory system RC705-779 Konstantinos G. Kyriakoulis Anastasios Kollias George E. Diakos Ioannis P. Trontzas Eleni Fyta Nikolaos K. Syrigos Garyphallia Poulakou Chlamydia pneumoniae-associated pleuropericarditis: a case report and systematic review of the literature
description	Abstract 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.
format	article
author	Konstantinos G. Kyriakoulis Anastasios Kollias George E. Diakos Ioannis P. Trontzas Eleni Fyta Nikolaos K. Syrigos Garyphallia Poulakou
author_facet	Konstantinos G. Kyriakoulis Anastasios Kollias George E. Diakos Ioannis P. Trontzas Eleni Fyta Nikolaos K. Syrigos Garyphallia Poulakou
author_sort	Konstantinos G. Kyriakoulis
title	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_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_sort	chlamydia pneumoniae-associated pleuropericarditis: a case report and systematic review of the literature
publisher	BMC
publishDate	2021
url	https://doaj.org/article/af2644c69b104dd8acd9ba701ad7d215
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Chlamydia pneumoniae-associated pleuropericarditis: a case report and systematic review of the literature

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