HIV induced pericarditis differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ramyar Ghandriz MD[2]

Overview

HIV pericarditis must be differentiated based on existence of pericarditis and reason of pericarditis, so the below is the differential according to these two different basis.

Differentiating HIV induced pericarditis from other Diseases

• HIV induced pericarditis usually remains sillent and is found during autopsies as a random co-existing condition.
• If it was symptomatic, we can differentiate underlying cause as below:

Diseases	Clinical manifestations					Para-clinical findings			Gold standard
	Symptoms			Physical examination
						Lab Findings		Histopathology and imaging
	Chest pain	Jugular vein	Dry cough with hemoptesis	Friction rub	Lymph-adenopathy	Sputom cuture	Histological demonestration
Tuberculosis	+	elevated	If +, increases the risk	+	+/-	+	-	Active caseating granuloma in lungs	Treat all HIV induced pericarditis for tuberclosis. if not clinically improved, search for other diseases.
Congestive cardiomypathy	+	not elevated	-	-	-	-	-	Causes detectable CXR changes.
pneumocystis	+	+	-	+	-	+	-	Detectable by unique shape and pathologic features
CMV	+	+	-	+	+	-	+	Detecting pathologic giant CD8+ T-cell
Kaposi sarcoma	+	+	-	+	+	-	+	Specific skin and GI manifestations
Lymphoma	+	+	-	+	+	-	+	Lymph node excision and frozen section manifest unique features

Differential diagnosis of pericarditis

Chest pain or pressure are common symptoms. A small effusion may be asymptomatic. Larger effusions may cause cardiac tamponade, a life-threatening complication and the signs of impending tamponade include dyspnea, low blood pressure, and distant heart sounds. There are several other cardiac insults with similar symptoms that should be considered in differential diagnosis of pericardial effusion.

Differential Diagnosis by Organ System

Cardiovascular	Cathether ablation for arrhythmias, coronary artery bypass grafting, dissecting aortic aneurysm, Dresslers syndrome, endocarditis, myocarditis, pacemaker insertion, percutaneous coronary intervention, postpericardiotomy syndrome, TAVI, thoracic surgery, valvuloplasty
Chemical / poisoning	Silicosis
Dermatologic	Behcet syndrome
Drug Side Effect	Dantrolene, doxorubicin, hydralazine, isoniazid, penicillin, phenylbutazone, procainamide
Ear Nose Throat	Temporal arteritis
Endocrine	Addisonian crisis, Severe hypothyroidism (myxedema)
Environmental	No underlying causes
Gastroenterologic	Inflammatory bowel disease, Whipple's
Genetic	Gaucher disease, Jacobs arthropathy-camptodactyly syndrome, Mulibrey nanism syndrome, recurrent hereditary polyserositis
Hematologic	Leukemia, lymphoma
Iatrogenic	Cardiopulmonary resuscitation, postpericardiotomy syndrome, radiation therapy, serum sickness, thoracic duct obstruction secondary to tumor, surgery
Infectious Disease	Actinomycosis, adenovirus, alveolar hydatid disease, amebiasis, aspergillus, blastomycosis, borrelia, brucellosis, candida, coccidiomycosis, coxsackie B virus, cytomegalovirus, Ebstein-Barr virus, echinococcus, echovirus, entamoeba histolytica, escherichia coli, francisella, haemophilus influenza, hepatitis B, histoplasmosis, influenza, klebsiella, legionella, Lyme disease, meningococci, mumps, mycoplasma pnuemonia, neisseria, nocardia, pneumococcus, proteus, pseudomonas, rickettsia, salmonella, staphylococcus, streptococcus, toxoplasmosis, tuberculous, tularemia, varicella
Musculoskeletal / Ortho	No underlying causes
Neurologic	No underlying causes
Nutritional / Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	Breast cancer, carcinoid, fibroma, kaposis sarcoma, leukemia, lipoma, lung cancer, lymphomas, melanoma, mesothelioma, ovarian cancer, sarcoma, Sipple syndrome
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	Sarcoidosis
Renal / Electrolyte	Uremia
Rheum / Immune / Allergy	Acute rheumatic fever, amyloidosis, ankylosing spondylitis, Behcet syndrome, Kawasaki disease, mixed connective tissue disease, polyarteritis nodosa, polymyositis, Reiter's Syndrome, rheumatoid arthritis, sarcoidosis, scleroderma, Still's disease, systemic lupus erythematosus, systemic sclerosis, temporal arteritis, Wegener's
Sexual	Neisseria gonorrhoeae, treponema pallidum
Trauma	Blunt or penetrating chest trauma, esophageal rupture, esophogeal perforation, gastric perforation, pancreatic-pericardial fistula
Urologic	Renal Failure, uremia
Miscellaneous	Idiopathic