Adenosine Deaminase Diagnostic Testing in Pericardial Fluid

Edward Chau, Minoo Sarkarati,Brad Spellberg

JAMA. 2019;322(2):163-164. doi:10.1001/jama.2019.7535

Case

A 65-year-old Vietnamese man with hypertension, type 2 diabetes mellitus, and chronic hepatitis B with cirrhosis presented with a 2-week history of shortness of breath at rest, orthopnea, and lower extremity edema. He reported a 4-month history of nonproductive cough, 5-kg weight loss, and fatigue. He immigrated to the United States as an adult more than 20 years before presentation. His temperature was 37°C, heart rate was 78/min, respiratory rate was 17/min, and blood pressure was 158/95 mm Hg. A chest radiographic image suggested cardiomegaly and a computed tomographic scan demonstrated a moderate to large pericardial effusion. A pericardial drain was placed and pericardial fluid was sent to the laboratory for evaluation. Initial pericardial fluid study results are presented in the Table. Empirical treatment for tuberculosis was initiated. Three days later, an adenosine deaminase (ADA) level of 118.1 U/L (normal range, 0.0-11.3 U/L) from pericardial fluid was reported from the laboratory.

一名65岁越南裔男性既往患有高血压、2型糖尿病及慢性乙型肝炎伴肝硬化。患者因静息状态下呼吸困难、端坐呼吸及下肢水肿2周就诊。患者还主诉干咳4个月，体重下降5 kg，且有明显乏力。患者成年后移民至美国，至就诊时在美国生活已超过20年。患者体温37°C，心率78 bpm，呼吸频率17 bpm，血压158/95 mmHg。胸片提示心脏扩大，CT显示中到大量心包积液。遂置入心包引流管并将心包积液送检。心包积液的化验结果见下表。开始经验性抗结合治疗。3天后，心包积液腺苷脱氨酶(ADA)结果回报，为118.1 U/L（正常范围，0.0-11.3 U/L）