A Case of Recurrent Pericarditis in Association With Asymptomatic Urethral Chlamydia trachomatis Infection

Extragenital manifestations of Chlamydia trachomatis infection can be challenging to diagnose. A previously healthy 33-year-old man presented with pericarditis recurring despite anti-inflammatory therapy and progressing to cardiac tamponade. Pericardiocentesis yielded bloody-appearing fluid with increased neutrophils and negative standard cultures. The patient reported recent unprotected sexual exposure, and urine nucleic acid amplification test detected C. trachomatis. He had no urogenital, ocular, or joint symptoms. The result of an extensive workup for other causes of pericarditis was negative, including HLA-B27 testing. He was treated with an extended course of doxycycline with full resolution of symptoms. We found 4 previously reported cases of chlamydial myopericardial disease, all of which shared key features with ours. Differentiating disseminated C. trachomatis from reactive phenomena is currently difficult owing to the limited availability of molecular tests and lack of their validation for clinical use. The diagnosis remains one of the clinical suspicions and circumstantial pieces of evidence, and further diagnostic developments are needed.