Key result
Conservative management with pericardiocentesis, drainage, and colchicine resulted in complete resolution of the pericardial effusion and normalization of cardiac function over 1 year without surgery.
Why the study?
Cholesterol pericarditis is a rare pericardial disease often associated with rheumatoid arthritis, with limited data on effective management strategies.
Case Report (n=1)
Conservative, non-surgical management using pericardiocentesis and adjunctive colchicine may be a safe and effective definitive treatment strategy for RA-associated cholesterol pericarditis complicated by tamponade.
May support non-surgical management in RA-associated cholesterol pericarditis with tamponade; leaves open generalizability beyond this single case.
Background: Cholesterol pericarditis is a rare form of pericardial disease characterised by chronic cholesterol-rich pericardial effusions, commonly associated with rheumatoid arthritis (RA), hypothyroidism, or tuberculosis. These effusions may progress to cardiac tamponade, requiring urgent intervention. Case Presentation: A 66-year-old male with RA presented with fatigue and dyspnoea and was found to have a large pericardial effusion with echocardiographic evidence of cardiac tamponade. Initial pericardiocentesis drained 600 mL of cholesterol crystal-containing fluid; however, rapid reaccumulation required repeat drainage with temporary catheter placement. Pericardial fluid analysis demonstrated elevated cholesterol (80 mg/dL), markedly elevated lactate dehydrogenase (>2500 U/L), and inflammatory cell predominance, with negative cultures and cytology. The patient was managed with pericardiocentesis, drainage, colchicine, and continuation of RA-directed therapy without surgical intervention. Over 1 year, serial echocardiography demonstrated normalisation of cardiac function and complete resolution of the effusion. Conclusion: This case highlights that conservative, non-surgical management may be effective in selected patients with RA-associated cholesterol pericarditis complicated by tamponade. A structured diagnostic approach and individualised management strategy are critical in optimising outcomes.
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Marciniak et al. (2026) conducted a case report in Cholesterol pericarditis with cardiac tamponade associated with rheumatoid arthritis (n=1). Pericardiocentesis, drainage, and medical therapy (colchicine) was evaluated on Resolution of pericardial effusion and restoration of cardiac function. Conservative management with pericardiocentesis, drainage, and colchicine resulted in complete resolution of the pericardial effusion and normalization of cardiac function over 1 year without surgery.
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