Cardiac Tamponade in HIV- A Rare Cause

Pericardial effusion is seen in 25% of HIV patients with advanced disease on echocardiography. But cardiac tamponade is rare in HIV. Here we report an interesting case of cardiac tamponade in HIV secondary to Burkholderia cepacia (B. cepacia) infection. Citation: Agarwal N (2018) Cardiac Tamponade in HIVA Rare Cause. J AIDS Clin Res 9: 769. doi: 10.4172/2155-6113.1000769

A 46 year old heterosexual male on antiretroviral treatment for five years, presented with high grade fever and left sided chest pain for fifteen days. Chest pain increased on movement, coughing and deep breath. There was no history of cough, expectoration, haemoptysis, trauma, rash, joint pain. There was history of occasional alcohol intake. On examination, patient was conscious, oriented and pale. Pulse was 104 per min. Blood pressure was 110/70 mm. Pulsus paradoxus of 18 mm was present. Jugular venous pressure was increased 8 cm above sternal angle. Chest was clear and there was no pleural rub. On cardiovascular examination, heart sounds were muffled. Pericardial friction rub was present.

Discussion
Average incidence of pericardial disease in HIV [2] is 21%. Most cases are asymptomatic [3]. Gowda  Chen et al. reported that cardiac tamponade was seen in 16 of the 40 cases of pericardial effusion in HIV [5]. B. cepacia is an opportunistic pathogen seen commonly in patients with cystic fibrosis, chronic granulomatous diseases and sickle cell haemoglobinopathies. It can cause life threatening infections like pneumonia, meningitis, peritonitis and endocarditis in these patients. But pericardial effusion due to B. cepacia is rare. Only two cases have been reported so far , one in an immmunocompetant child by Sharma et al. [6] and other in HIV secondary to video assisted thoracoscopic surgery [7]. It is important as an upcoming nosocomial pathogen resistant to common antibiotics in the era of increasing drug resistance. Treatment is given for 4 weeks guided by sensitivity report.

Summary
Pericardial effusion is common in HIV but tamponade is rare and B. cepacia as the causative organism is very rare. It is both difficult to isolate and treat.

Learning points
• Cardiac tamponade is rare in HIV.
• B. cepacia is rare cause for haemorrhagic pericardial effusion, difficult to isolate & resistant to commonly used antibiotics.
• Treatment is given for 4 weeks.