Acute fibrinous constrictive pericarditis and large pericardial effusion as the first manifestation of systemic lupus erythematsous disease in an adult male patient

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Acute fibrinous constrictive pericarditis and large pericardial effusion as the first manifestation of systemic lupus erythematosus (SLE) (n=1). Intervention: Ibuprofen and colchicine followed by prednisolone and hydroxychloroquine. Primary outcome: Complete resolution of symptoms, pericardial fibrin strands, pericardial effusion, and constrictive physiology without pericardiocentesis.

Q: What does this research mean for the field?

Acute fibrinous constrictive pericarditis with large pericardial effusion can occur as the initial manifestation of systemic lupus erythematosus in adult males and can achieve complete resolution with corticosteroid and hydroxychloroquine therapy without invasive intervention. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Hannaneh Yousefi‐Koma; Rozita Jalalian; Babak Bagheri

doi:10.1002/ccr3.7958

September 27, 2023Clinical Case ReportsOpen Access

Acute fibrinous constrictive pericarditis and large pericardial effusion as the first manifestation of systemic lupus erythematsous disease in an adult male patient

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Key result

Corticosteroids plus hydroxychloroquine completely resolve acute lupus-induced fibrinous constrictive pericarditis within 6 weeks.

n=1

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Graphical abstract published by Clinical Case Reports — Graphical abstract · Published by Clinical Case Reports · CC BY-NC-ND

Why the study?

Severe acute pericarditis as the first manifestation of systemic lupus erythematosus in a male patient is relatively rare.

Key Points

Document the diagnosis and medical management of acute fibrinous constrictive pericarditis presenting as the initial manifestation of systemic lupus erythematosus (SLE) in an adult male.
Evaluated a 36-year-old male presenting with pleuritic chest pain, dyspnea, fever (39.5°C), and high-risk features of acute pericarditis.
Performed transthoracic echocardiography, Doppler imaging, chest computed tomography, and autoimmune serological testing.
Treated with non-steroidal anti-inflammatory drugs and corticosteroids, followed by hydroxychloroquine and tapered prednisolone (starting at 30 mg daily).
Diagnostic workup revealed positive antinuclear antibodies (1/80) and elevated anti-dsDNA (51.5 IU/mL), meeting 2019 EULAR/ACR criteria for SLE with a score of 12.
All clinical symptoms and hemodynamic abnormalities completely resolved after 6 weeks of medical therapy without the need for pericardiocentesis.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

A 36-year-old Iranian male presenting with acute fibrinous constrictive pericarditis and large pericardial effusion as the initial manifestation of systemic lupus erythematosus, followed for 6 months.

I

Intervention

Initial treatment with oral ibuprofen 600 mg every 8 hours and colchicine 0.5 mg daily for 1 week, followed by addition of oral prednisolone 30 mg daily (0.5 mg/kg/day for 2 weeks, tapered to 25 mg daily for 4 weeks, and subsequently tapered to 10 mg daily) and replacement of NSAIDs with hydroxychloroquine 400 mg daily.

O

Outcome

Resolution of clinical signs and symptoms, complete resolution of pericardial fibrin strands and effusion, and reversal of constrictive hemodynamic pattern on Doppler echocardiography at 6 weeks without pericardiocentesis.hard clinical

Prompt etiological investigation of acute fibrinous constrictive pericarditis for autoimmune diseases such as SLE allows targeted immunosuppressive therapy with corticosteroids and hydroxychloroquine, achieving complete resolution and avoiding unnecessary pericardiocentesis or surgical pericardiectomy.

Limitations

Single-patient case report

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Implication

May warrant autoimmune evaluation in acute fibrinous constrictive pericarditis; hypothesis-generating for targeted immunosuppression in SLE.

Abstract

Systemic lupus erythematosus (SLE) can have various manifestations. Although cardiac involvement is very common in SLE patients, a severe acute pericarditis as the first manifestation of SLE in a male patient is relatively rare. A 36-year-old male was admitted to our hospital with acute pericarditis, large circumferential fibrinous pericarditis, and major criteria of a high-risk case of acute pericarditis. After a complete investigation, the underlying disease was revealed to be SLE. All of his symptoms were completely resolved after 6 weeks of treatment with non-steroidal anti-inflammatory drugs and corticosteroids with no need for a pericardiocentesis. Patients with acute fibrinous pericarditis should be considered and precisely investigated for multiorgan autoimmune process such as SLE, to avoid unnecessary intervention, and minimize the risk of recurrence and chronicity of the condition.

Discussion

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Cite This Study

Yousefi‐Koma et al. (2023) conducted a case report in Acute fibrinous constrictive pericarditis and large pericardial effusion as the first manifestation of systemic lupus erythematosus (SLE) (n=1). Ibuprofen and colchicine followed by prednisolone and hydroxychloroquine was evaluated on Complete resolution of symptoms, pericardial fibrin strands, pericardial effusion, and constrictive physiology without pericardiocentesis. Corticosteroids and hydroxychloroquine completely resolved acute fibrinous constrictive pericarditis and effusion within 6 weeks in a 36-year-old male with newly diagnosed SLE.

synapsesocial.com/papers/6a7b37a4a861e9f59932dd1e https://doi.org/10.1002/ccr3.7958

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Acute fibrinous constrictive pericarditis and large pericardial effusion as the first manifestation of systemic lupus erythematsous disease in an adult male patient

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Acute fibrinous constrictive pericarditis and large pericardial effusion as the first manifestation of systemic lupus erythematsous disease in an adult male patient

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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