Pericardial effusion and tamponade in the context of herpes zoster: a novel occurrence

Background: Pericarditis and pericardial effusion are relatively common hospital presentations, which rarely result in cardiac tamponade. The aetiology is often undetermined and presumed idiopathic or viral. This article reviews varicella zoster virus (VZV)-associated pericardial effusion and peri/myopericarditis and constitutes the first report of VZV-associated cardiac tamponade in the adult population. Case summary: We report the case of a 59-year-old woman who presented to hospital with pleuritic chest pain, haemodynamic instability, and a recent herpes zoster rash in the left T1 distribution. Computed tomography revealed a large pericardial effusion, and echocardiography showed features of cardiac tamponade. The patient was treated with pericardial drainage. Aspirate analysis revealed abundant polynuclear cells and histocytes with no organism. Polymerase chain reaction did not determine a cause. Discussion: There are 13 reported cases of VZV-associated peri/myopericarditis in adults in the literature published in the English language. Of these, only three patients had a pericardial effusion. Aetiological diagnosis of an effusion is challenging and rarely made on virological grounds but rather on clinical features. Varicella zoster virus-associated pericardial effusion should be considered in patients presenting with haemodynamic instability and a dermatomal rash affecting the C3-C5 and T1-T4 distributions.