Edward Chau, Minoo Sarkarati,Brad Spellberg<\/h3>\n\n\n\nJAMA. <\/em>2019;322(2):163-164. doi:10.1001\/jama.2019.7535<\/h3>\n\n\n\nCase<\/h2>\n\n\n\n
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\u00b0<\/strong>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<\/a>. 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.<\/p>\n\n\n\n\u4e00\u540d65\u5c81\u8d8a\u5357\u88d4\u7537\u6027\u65e2\u5f80\u60a3\u6709\u9ad8\u8840\u538b\u30012\u578b\u7cd6\u5c3f\u75c5\u53ca\u6162\u6027\u4e59\u578b\u809d\u708e\u4f34\u809d\u786c\u5316\u3002\u60a3\u8005\u56e0\u9759\u606f\u72b6\u6001\u4e0b\u547c\u5438\u56f0\u96be\u3001\u7aef\u5750\u547c\u5438\u53ca\u4e0b\u80a2\u6c34\u80bf2\u5468\u5c31\u8bca\u3002\u60a3\u8005\u8fd8\u4e3b\u8bc9\u5e72\u54b34\u4e2a\u6708\uff0c\u4f53\u91cd\u4e0b\u964d5 kg\uff0c\u4e14\u6709\u660e\u663e\u4e4f\u529b\u3002\u60a3\u8005\u6210\u5e74\u540e\u79fb\u6c11\u81f3\u7f8e\u56fd\uff0c\u81f3\u5c31\u8bca\u65f6\u5728\u7f8e\u56fd\u751f\u6d3b\u5df2\u8d85\u8fc720\u5e74\u3002\u60a3\u8005\u4f53\u6e2937\u00b0<\/strong>C\uff0c\u5fc3\u738778 bpm\uff0c\u547c\u5438\u9891\u738717 bpm\uff0c\u8840\u538b158\/95 mmHg\u3002\u80f8\u7247\u63d0\u793a\u5fc3\u810f\u6269\u5927\uff0cCT\u663e\u793a\u4e2d\u5230\u5927\u91cf\u5fc3\u5305\u79ef\u6db2\u3002\u9042\u7f6e\u5165\u5fc3\u5305\u5f15\u6d41\u7ba1\u5e76\u5c06\u5fc3\u5305\u79ef\u6db2\u9001\u68c0\u3002\u5fc3\u5305\u79ef\u6db2\u7684\u5316\u9a8c\u7ed3\u679c\u89c1\u4e0b\u8868\u3002\u5f00\u59cb\u7ecf\u9a8c\u6027\u6297\u7ed3\u5408\u6cbb\u7597\u30023\u5929\u540e\uff0c\u5fc3\u5305\u79ef\u6db2\u817a\u82f7\u8131\u6c28\u9176(ADA)\u7ed3\u679c\u56de\u62a5\uff0c\u4e3a118.1 U\/L\uff08\u6b63\u5e38\u8303\u56f4\uff0c0.0-11.3 U\/L\uff09<\/p>\n\n\n\n![\"\"\/](\"https:\/\/cdn.jamanetwork.com\/ama\/content_public\/journal\/jama\/938092\/jdt190002t1.png?Expires=2147483647&Signature=Ia8k2i6~bprgA2GNGymj5nbVZ51Vq81Uul4JXInuA8iXakS-YgzQ0WTkxAnw2ldXp0x92sYIlGOzqwHD71Qp2OWHW4AbQC9wPC5FZBcTHs2DzOIWC4xsOaXgqF-9XJGJKSN9m-9VPPLfnvWsWk19onkh-MlkcACtVQzsxPj82lpPiIbKPdH~2~uuJuEFuCDGoHkiMKhMC96KPmypGr5eflN5DfnAzz9IppiiFRUMZL4rKomce8EjSrUlVX3Di8si5qK8tEF4UuJ0oog7QVgVpa8rzAlIs7K61R~zV2Rzsb~387L1UkAC6X1qSEdNwgn40mn~5WEcOlVDPZtvWdHsGw__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA\")
<\/figure>\n\n\n\n\n\t
Case<\/h2>\n\n\n\n
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\u00b0<\/strong>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<\/a>. 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.<\/p>\n\n\n\n \u4e00\u540d65\u5c81\u8d8a\u5357\u88d4\u7537\u6027\u65e2\u5f80\u60a3\u6709\u9ad8\u8840\u538b\u30012\u578b\u7cd6\u5c3f\u75c5\u53ca\u6162\u6027\u4e59\u578b\u809d\u708e\u4f34\u809d\u786c\u5316\u3002\u60a3\u8005\u56e0\u9759\u606f\u72b6\u6001\u4e0b\u547c\u5438\u56f0\u96be\u3001\u7aef\u5750\u547c\u5438\u53ca\u4e0b\u80a2\u6c34\u80bf2\u5468\u5c31\u8bca\u3002\u60a3\u8005\u8fd8\u4e3b\u8bc9\u5e72\u54b34\u4e2a\u6708\uff0c\u4f53\u91cd\u4e0b\u964d5 kg\uff0c\u4e14\u6709\u660e\u663e\u4e4f\u529b\u3002\u60a3\u8005\u6210\u5e74\u540e\u79fb\u6c11\u81f3\u7f8e\u56fd\uff0c\u81f3\u5c31\u8bca\u65f6\u5728\u7f8e\u56fd\u751f\u6d3b\u5df2\u8d85\u8fc720\u5e74\u3002\u60a3\u8005\u4f53\u6e2937\u00b0<\/strong>C\uff0c\u5fc3\u738778 bpm\uff0c\u547c\u5438\u9891\u738717 bpm\uff0c\u8840\u538b158\/95 mmHg\u3002\u80f8\u7247\u63d0\u793a\u5fc3\u810f\u6269\u5927\uff0cCT\u663e\u793a\u4e2d\u5230\u5927\u91cf\u5fc3\u5305\u79ef\u6db2\u3002\u9042\u7f6e\u5165\u5fc3\u5305\u5f15\u6d41\u7ba1\u5e76\u5c06\u5fc3\u5305\u79ef\u6db2\u9001\u68c0\u3002\u5fc3\u5305\u79ef\u6db2\u7684\u5316\u9a8c\u7ed3\u679c\u89c1\u4e0b\u8868\u3002\u5f00\u59cb\u7ecf\u9a8c\u6027\u6297\u7ed3\u5408\u6cbb\u7597\u30023\u5929\u540e\uff0c\u5fc3\u5305\u79ef\u6db2\u817a\u82f7\u8131\u6c28\u9176(ADA)\u7ed3\u679c\u56de\u62a5\uff0c\u4e3a118.1 U\/L\uff08\u6b63\u5e38\u8303\u56f4\uff0c0.0-11.3 U\/L\uff09<\/p>\n\n\n\n<\/figure>\n\n\n\n