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Mesothelioma is a malignancy originating from the epithelial cells of the mesothelium. Primary malignant pericardial mesothelioma is an extremely rare disease with a reported incidence of 0.0022%.1) Initial presenting symptoms of this disease are dyspnea, fever and chest pain. Patients may also suffer from acute myocardial infarction or embolic stroke due to extension of tumor into myocardium or cardiac chambers. Chest X-ray may shows cardiomegaly and echocardiographic examination Inhibitors,research,lifescience,medical frequently reveals pericardial effusion.

Because presenting signs and symptoms are non-specific, diagnosis of this disease is often misleading. The disease has occurred predominantly in men, with the majority of cases occurring in the fifth to seventh Inhibitors,research,lifescience,medical decades of life.2) The prognosis is find more dismal, even with radio- and chemotherapy. We report a case of primary

malignant pericardial mesothelioma initially presenting as acute pericarditis. Case A 21-year-old man was transferred to our hospital because of cough with sputum, and dyspnea beginning 14 days prior to admission. The cough was persistent Inhibitors,research,lifescience,medical and associated with intermittent fever up to 38.3℃. The patient had been well until 2 weeks earlier, when he inoculated with influenza vaccine (H1N1). Five days before admission, he visited another hospital because of chest pain and aggravating dyspnea. Thoracic echocardiography showed large amount pericardial effusion with impending tamponade. Inhibitors,research,lifescience,medical The patient was transferred to this hospital for pericardiocentesis. On arrival in the emergency department, the patient reported fever, chills, pleuritic chest pain and orthopnea. On examination, the blood pressure was 105/78 mmHg, the pulse 97 beats per minute, and the temperature was 37.4℃. The heart rhythm was regular without murmur. Initial white blood cell count showed 11900 per microliter of which 71.6% were segmented neutrophils. C-reactive protein (CRP) was elevated Inhibitors,research,lifescience,medical up to 15 mg/dL. Chest X-rays revealed moderate cardiomegaly.

A 12-lead electrocardiogram demonstrated regular sinus tachycardia with anterior, inferior lead ST-segment elevation. An echocardiography revealed moderate pericardial effusion (Fig. 1) and dilatation of inferior vena cava. Fig. 1 Pericardial effusion on initial echocardiographic evaluation. Emergency pericardiocentesis was performed and clear and yellowish effusion was drained. Lactate dehydrogenase GBA3 of pericardial fluid was 937 IU/L, and ADA was 11 IU/L. Pericardial fluid analysis showed 900 white blood cells per microliter of which 78% were segmented neutrophils. Cytological examinations were negative for malignant cells, and cultures and smears for bacteria, acid-fast bacilli, and fungi were negative. The patient was tentatively diagnosed with viral pericarditis and given nonsteroidal anti-inflammatory drugs (NSAIDs) and colchicine.