Resolved heart tamponade and controlled exophthalmos, facial pain and diabetes insipidus due to Erdheim-Chester disease.

Abstract

A 69-year-old woman suffering from exophthalmos and facial pain came to us referred for aetiological diagnosis of exophthalmos. Orbital MRI showed thinned extrinsic ocular musculature, intraconal fat infiltration, retro-ocular compression and thickening of maxillary and sphenoid sinus walls. She had been suffering from diabetes insipidus for the last 7 years. During our diagnosis process, she presented signs of cardiac tamponade. Transthoracic heart ultrasound revealed large pericardial effusion and a heterogeneous mass that compressed the right ventricle. No osteosclerotic lesions on appendicular bones were present. Pericardiocentesis temporarily controlled tamponade and corticoid therapy temporarily abated exophthalmos. Pericardiectomy definitively resolved tamponade. Histological examination of pericardial tissue was conclusive of Erdheim-Chester disease. Exophthalmos responded to pegylated interferon-alpha-2a. Facial bone pain disappeared after zoledronic acid and interferon treatment. During interferon therapy, the patient suffered from a severe generalised desquamative exanthema that slowly resolved after discontinuing interferon. Diabetes insipidus remains controlled with desmopressin.

• Authors: Jaume Monmany, Esther Granell, Laura López, Pere Domingo
• Journal: BMJ case reports (BMJ Case Rep) Vol. 2018 (Oct 17 2018) ISSN: 1757-790X [Electronic] England
• PMID: 30337283 (Publication Type: Case Reports, Journal Article)
• Copyright: © BMJ Publishing Group Limited 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Topics

• Aged
• Cardiac Tamponade (etiology, surgery)
• Diabetes Insipidus (complications, drug therapy)
• Diagnosis, Differential
• Echocardiography (methods)
• Erdheim-Chester Disease (complications, pathology)
• Exophthalmos (diagnostic imaging, drug therapy, etiology)
• Facial Pain (diagnosis, drug therapy, etiology)
• Female
• Humans
• Magnetic Resonance Imaging (methods)
• Pericardial Effusion (diagnostic imaging)
• Pericardiocentesis (methods)
• Rare Diseases
• Treatment Outcome