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Recurrent acute pericarditis diagnosed by extra-cellular volume maps

Year: 2021

Type: article

Abstract: A 21-year-old Nigerian man presented with chest pain and widespread ST segment elevation suggesting acute pericarditis. Blood tests showed elevated CRP (385 mg/dL) and ESR (50 mm/h). Troponin-T was normal. Echocardiography showed moderate pericardial effusion. Treatment with colchicine was started with prompt improvement. Past medical history included two previous episodes of pericarditis. He had received the Bacillus Calmette-Guérin vaccination but had history of contact with tuberculosis (TB). Infection screen documented a positive T-spot; autoimmune screen showed negative ANCA, ANA, ENA, and dsDNA, no evidence of complement consumption and normal IgG4. There was significant soluble IL2RA (3774 ng/mL) and slight IL-6 (29.8 ng/mL) elevation. A cardiovascular MRI (CMR) showed thickened pericardium with enhancement on post-gadolinium images mainly around the right ventricle free-wall (Panel A) with matching high extra-cellular volume (ECV) (Panel B) in keeping with inflammation. The myocardium was normal. Pericardial biopsy showed an exudative effusion with...

Source: European Heart Journal

DOI: 10.1093/eurheartj/ehab341

Authors: Benedict McDonaugh, Natalia Perepelova, Peter Kellman, James B Galloway, Stefania Rosmini

Institutions: King's College Hospital NHS Foundation Trust, National Institutes of Health, National Heart, Lung, and Blood Institute, King's College London

Language: English

Topic: Pericarditis and Cardiac Tamponade

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: green

Funder: National Institutes of Health