In a sticky situation: a case report on pulmonary glue embolism complicated by an inflammatory myopericardial syndrome.

Background: Tissue glue is used in a wide range of different medical procedures and although complications are rare, they can be challenging to manage. Case summary: A 51-year old man presented to our hospital with progressive dyspnoea, haemoptysis and fever following cyanoacrylate injection therapy for erectile dysfunction. A CT-scan revealed a non-thrombotic pulmonary embolism (NTPE) with tissue glue based on the non-contrast images showing multiple radiodense foci. During admission, the patient experienced chest pain and syncope after which a repeat electrocardiogram showed an increase in widespread concave ST segment elevation. A transthoracic echocardiography showed a diffuse pericardial effusion with partial atrial collapse without signs of pericardial tamponade. The diagnosis of an inflammatory myopericardial syndrome (IMPS) was made and therapy with high-dose aspirin combined with colchicine was started. Conclusion: NTPE and IMPS are rare but potentially life-threatening complications associated with nearly all procedures involving tissue glue. The simultaneous occurrence of these complications might suggest an underlying hypersensitivity-driven inflammatory cascade as mechanism. Using a non-contrast window on the CT scan is important to avoid missing a NTPE.