Aggressive Cholesterol Pericarditis With Minimal Effusion Masquerading as Treatment-Refractory Autoimmune DiseaseNovel Teaching Points
Tahir S. Kafil, MD, FRCPC,
Elena Tugaleva, MD, FRCPC,
Muhammad M. Hashmi, MD,
Omar Shaikh, BHSc,
Yehia Fanous, MD,
Tahir Dahrouj, BHSc,
Maged Elrayes, MD,
Lin-Rui Ray Guo, MD, FRCSC,
Rodrigo Bagur, MD, PhD, FRCPC,
Nikolaos Tzemos, MD, FRCPC
Affiliations
Tahir S. Kafil, MD, FRCPC
Department of Cardiology, London Health Sciences Centre, Western University, London, Ontario, Canada
Elena Tugaleva, MD, FRCPC
Department of Pathology, London Health Sciences Centre, London, Ontario, Canada
Muhammad M. Hashmi, MD
MD Program, St. George's University School of Medicine, Grenada, West Indies
Omar Shaikh, BHSc
MD Program, University of Toronto, Toronto, Ontario, Canada
Yehia Fanous, MD
Department of Internal Medicine, Western University, London, Ontario, Canada
Tahir Dahrouj, BHSc
MD Program, Western University, London, Ontario, Canada
Maged Elrayes, MD
Department of Cardiology, London Health Sciences Centre, Western University, London, Ontario, Canada
Lin-Rui Ray Guo, MD, FRCSC
Division of Cardiac Surgery, Western University, London, Ontario, Canada
Rodrigo Bagur, MD, PhD, FRCPC
Department of Cardiology, London Health Sciences Centre, Western University, London, Ontario, Canada
Nikolaos Tzemos, MD, FRCPC
Department of Cardiology, London Health Sciences Centre, Western University, London, Ontario, Canada; Corresponding author: Dr Nikolaos Tzemos, Department of Cardiology, Western University, LHSC University Hospital, 339 Windermere Rd, London, Ontario N6A 5A5, Canada. Tel.: +1-519-663-3038.
A middle-aged woman with rheumatoid arthritis presented with treatment-refractory pericarditis. Symptoms persisted despite escalation of immunosuppression, and she had recurrent admissions for heart failure. Imaging revealed minimal pericardial effusion and a thickened pericardium. Invasive hemodynamics confirmed constrictive physiology, and a pericardiectomy was required. Pathology testing confirmed cholesterol pericarditis, a rare condition of inflammatory cholesterol deposits within the pericardium. Previous reports describe moderate-to-large volumes of gold-coloured pericardial fluid. This case illustrates that cholesterol pericarditis can present with minimal pericardial effusion and rapidly progress to pericardial constriction. Résumé: Une femme d’âge moyen atteinte d’arthrite rhumatoïde a présenté une péricardite réfractaire. Les symptômes ont persisté en dépit de l’escalade de l’immunodépression. Elle a été admise de façon répétitive en raison d’insuffisance cardiaque. L’imagerie a révélé un épanchement péricardique minimal et un péricarde épaissi. L’exploration hémodynamique invasive a permis de confirmer la physiologie constrictive. Une péricardectomie a été nécessaire. L’examen pathologique a permis de confirmer la péricardite cholestérolique, une affection inflammatoire rare due aux dépôts de cholestérol dans le péricarde. Les observations précédentes décrivent des volumes modérés à élevés de liquide péricardique doré. Ce cas illustre que la péricardite cholestérolique peut se traduire par un épanchement péricardique minimal et progresser rapidement vers la péricardite constrictive.
