A 34-Year-Old Woman Is Evaluated in the Emergency Department Due

A 34-year-old woman is evaluated in the emergency department due to 1-day of chest and left shoulder pain.  The patient describes the pain as constant and worse in certain positions.  A month ago, she was treated for a skin rash and joint pain.  Her medical history is otherwise unremarkable.  She is a lifetime nonsmoker and does not use alcohol or illicit drugs.  Her father has hypertension and had a stroke at age 64.  Temperature is 37.5 C (99.5 F) , blood pressure is 122/70 mm Hg, and pulse is 97/min and regular.  A triphasic, scratchy sound is heard over the left sternal border with the patient sitting up.  The lungs are clear on auscultation.  ECG shows sinus rhythm with ST-segment elevation in all leads except avR and V1.  Which of the following is the most likely diagnosis?

A) Eosinophilic myocarditis
B) Fibrinous pericarditis
C) Hemorrhagic pericarditis
D) Nonbacterial endocarditis
E) Purulent pericarditis

Correct Answer:

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