Pericarditis as the Presenting Sign of Crohnʼs Disease

To the Editor: A 32-year-old woman presented to the emergency department for evaluation of a febrile illness and shortness of breath. Her symptoms had commenced 2 weeks before with headache, rhinorrhea, and sore throat. During the next week, these symptoms gave way to a nonproductive cough and low-grade fever. She also complained of pleurisy in her left hemithorax, describing it as constant and accentuated by any movement, including cough and sitting upright. Her medical history was remarkable for a vaginal delivery 3 years before that was followed 6 months later by deep venous thrombosis with pulmonary embolism, for which she completed 6 months of coumadin therapy. She had been hospitalized for a similar illness 2 years before and had received a diagnosis of idiopathic pericarditis. Electrocardiogram (ECG) and echocardiogram findings at that time were interpreted as within normal limits. At the same time, she experienced a week-long episode of watery diarrhea with crampy, abdominal pain. After failing to respond to high-dose aspirin and naproxen, she experienced prompt relief of both chest pain and diarrhea when given a short course of high-dose prednisone.