Acute Pericarditis Associated with Chronic Hepatitis B Virus Infection: a case Report and review of the Literature

Abstract

1. INTRODUCTIONAcute pericarditis is defined as inflammation of the pericardial sac, which comprises a thin fibrous outer layer and an inner serous layer that normally contains a few milliliters of lubricating fluid(1,2). Inflammation typically causes sharp, pleuritic chest pain that worsens when lying supine and improves when sitting up and leaning forward, often accompanied by a pericardial friction rub and characteristic electrocardiographic changes(1,3). Other nonspecific symptoms may include tachycardia, dyspnea, cough, low-grade fever, leg swelling, palpitations, and malaise(4,5). It most commonly affects young adults(3,6).Diagnosis is primarily clinical, requiring at least two of the following: positional pleuritic chest pain, pericardial friction rub, ECG changes with diffuse ST-segment elevation or PR-segment depression, or new pericardial effusion(1,3,6). Acute pericarditis can mimic myocardial infarction; however, troponin levels are typically only mildly elevated in isolated pericarditis. Echocardiography identifies pericardial effusion in approximately 50–60% of cases, although its absence does not exclude the diagnosis(1). Supportive laboratory findings include elevated inflammatory markers such as ESR and CRP(1,3,7). Friction rubs, though highly specific, are audible in only up to 30% of patients(1).Pericarditis is a relatively common cause of non-ischemic chest pain, accounting for approximately 5% of presentations in Western emergency cohorts(2). Idiopathic or presumed viral cases constitute the majority (>50%), followed by post-cardiac injury syndromes such as post-myocardial infarction or post-procedural pericarditis(1).In TB-endemic regions, tuberculous pericarditis predominates, representing up to 65–70% of effusive cases(8). Other causes include bacterial infection, malignancy, uremia, and systemic autoimmune diseases(3,6). Among viral causes, Coxsackievirus and echovirus are most common; although chronic hepatitis B virus infection is not a common cause, it may rarely contribute to pericardial inflammation(9).This report describes a young man with chronic HBV who presented with classical acute pericarditis, responded to standard anti-inflammatory therapy, and highlights diagnostic and management considerations when HBV is present.