Ascities and Constrictive Pericarditis as Primary Complications of Rheumatoid Arthritis Followed By Pericardial Effusion: A Case Report

Ascites as a symptom and sign of constrictive pericarditis is seen in association with rheumatoid arthritis, although the exact incidence is not clear.Pericarditis associated with rheumatoid arthritis was reported to occur in 10 of 403 (2.4%) patients studied by Connally and Burchell!.Bonfiglio and Atwater 2 reported that chronic pericarditis was th e most common rheumatoid lesion of the heart (36%) in 47 autopsied patients who had seropositive rheumatoid arthrit is.Other authors have noted the association of pericarditis and rheumatoid arthritis. 3,4 ,5 Keith 6 suggests that the association of rheumatoid arthritis and chro nic constrictive per icarditis is a rare occurrence.Somerville? points out that amo ng the comm on causes of constrictive pericarditis are tubercul osis, bacterial and viral inflamation, and neoplastic invasion.He suggest s, however, th at rheumatoid arthrit is is an uncommon cause of constricti ve pericarditis.In mo st of these reports an allusion is mad e to th e occurrence of ascites as a sequelum to pericarditis with effusion and tamponade .The mechanical and myocardial factors in chronic constrictive pericarditis have been described 8 previously.However aft er a search of th e literature, these authors are unaware of any case report which suggests that th e ascites develop ed before pericardial tamponade, and , in add it ion, there is a paucity of cases reporting the association of constrictive pericardit is with rheumatoid arthritis.It is then, because of this unusual presentation , that the following case is presented. Case ReportF.V . is a 42 year old cauc asian male social worker who was admitted on Mar ch 3, 1972, with a chief complaint of swelling with fluid and bloating of th e abdomen.He reported th at beginning approximately three weeks prior to admission he had noticed accumulation of fluid in his abdomen and some swelling of his legs which occurred over a period of 4 to 5 days.He had also noticed some bright red blood in the stool and on the tissue paper, and complained that hemorrhoids were becoming swollen and tender.Two weeks prior to admission the pat ient report ed to his family phy sician wh o examined his gastrointestinal tract radiologically and found a post-bulbar duodenal ulcer.The patient was tr eat ed wit h antaci ds, a bland diet , and probanthine .