Ramipril induced polyserositis with pericardial tamponade and pleural effusion.

摘要

A 63-year-old male patient was admitted to hospital with dyspnea at rest, tachycardia (120 beats/min), and mild hypotension (90/60 mm Hg) as well as muscle and joint pain. The medical history included the diagnosis of arterial hypertension which was treated with nitrendipine, ramipril, hydrochlorothiazide, and carvedilol for ten years. The chest CT-scan showed large pleural effusions on both sides as well as a substantial pericardial effusion (Fig. 1). The latter was of hemodynamic significance as demonstrated by echocardiography. Parameters of inflammation were increased (C-reactive protein 188 mg/1, white blood cell count 17.5 G/l). The initial diagnosis was myocarditis, and the patient was treated with corticosteroids. The patient was discharged after disappearance of all effusions and free of other symptoms. The antihypertensive medication, which has been stopped during the phase of hypotension, was started again with ramipril only. One week later, the patient was admitted to hospital again with the same symptoms mentioned above including all effusions. The corticosteroid therapy was repeated and all symptomes were succesfully treated. The patient was discharged with metoprolol as only antihypertensive therapy.