Pericardial tamponade associated with Epstein-Barr virus in an immunocompetent young patient

Acute pericarditis may result from many etiologies. Pericarditis as a complication of Epstein-Barr virus (EBV) infection is quite rare and is usually self-limited in immunocompetent patients. In particular, pericardial tamponade associated with EBV infection has been reported in only one case. An 18-year-old woman presented with chest pain and shortness of breath. Upon suspicion of pulmonary embolism, the patient was examined with computed tomography, which showed no pulmonary embolism, but massive pericardial fluid surrounding the whole pericardium. Transthoracic echocardiography revealed pericardial fluid collections in the posterolateral wall (3.5 cm), right ventricle (2 cm), and right atrium (1.4 cm), and a diastolic collapse of the right ventricular apical wall. Emergency pericardiocentesis was performed and a total of 750 ml fluid was removed, which resulted in hemodynamic improvement and disappearance of the diastolic collapse on echocardiography. Serum EBV VCA IgM and EBV PCR assays were found positive and medical therapy was instituted with the diagnosis of EBV-associated pericarditis. The patient showed complete improvement and was discharged. At one-month control, she was free of symptoms and her echocardiogram was normal.