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• Other treatable causes of recurrent pericarditis
  oscar,m jolobe
  Published on: 25 June 2020

• Published on: 25 June 2020

  Other treatable causes of recurrent pericarditis

  • oscar,m jolobe, retired geriatrician manchester medical society

  Among the underlying causes of recurrent pericarditis which require specific treatment strategies (1) mention must also be made of recurrent pericarditis attributable to coeliac disease(2)(3), and recurrent pericarditis attributable either to Type 2 autoimmune endocrinopathy(4) or to hypoadrenalism(5).
  Faizallah et al reported 3 patients aged 40, 40, and 56, respectively, with recurrent pericarditis attributable to coeliac disease. The first patient presented with a temperature of 38.5 degrees Celsius, pericardial friction rub, and macrocytic anaemia attributable to folate deficiency. Pericardiocentesis yielded blood stained fluid that tested negative on bacteriological and M tuberculosis culture. Viral studies were negative and there were no malignant cells in the pericardial fluid. He responded well to reducing doses of corticosteroid therapy. However, it was only after a relapse of pericarditis that he had a duodenal biopsy, the latter an evaluation which revealed histological stigmata of coeliac disease. He was subsequently managed with a gluten-free diet(GFD), concurrently with an attempt to taper off the corticosteroid treatment. In spite of two subsequent relapses, corticosteroid treatment was eventually permanently terminated without any further relapse of pericarditis. The second patient was on GFD as well as a small dose of prednisolone at the time of publication of the report. The third patient, characterised by two episodes of pericarditi...

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  Among the underlying causes of recurrent pericarditis which require specific treatment strategies (1) mention must also be made of recurrent pericarditis attributable to coeliac disease(2)(3), and recurrent pericarditis attributable either to Type 2 autoimmune endocrinopathy(4) or to hypoadrenalism(5).
  Faizallah et al reported 3 patients aged 40, 40, and 56, respectively, with recurrent pericarditis attributable to coeliac disease. The first patient presented with a temperature of 38.5 degrees Celsius, pericardial friction rub, and macrocytic anaemia attributable to folate deficiency. Pericardiocentesis yielded blood stained fluid that tested negative on bacteriological and M tuberculosis culture. Viral studies were negative and there were no malignant cells in the pericardial fluid. He responded well to reducing doses of corticosteroid therapy. However, it was only after a relapse of pericarditis that he had a duodenal biopsy, the latter an evaluation which revealed histological stigmata of coeliac disease. He was subsequently managed with a gluten-free diet(GFD), concurrently with an attempt to taper off the corticosteroid treatment. In spite of two subsequent relapses, corticosteroid treatment was eventually permanently terminated without any further relapse of pericarditis. The second patient was on GFD as well as a small dose of prednisolone at the time of publication of the report. The third patient, characterised by two episodes of pericarditis, was successfully managed solely on a GFD, and had remained free of relapses thereafter(2).
  Recurrent pericarditis was also reported by Laine and Holt in a 63 year old patient with coeliac disease(3). That patient experienced two episodes of pericarditis, each characterised by pleuritic pain in association with a pericardial friction rub(4).
  Recurrent pericarditis is also a feature of autoimmune endocrinopathy. Examples of this phenomenon were documented in patients with primary hypoadrenalism as well as in patients with primary hypothyroidism(4). Hypoadrenalism-related pericarditis may also be associated with life-threatening cardiac cardiac tamponade(5). In the latter report the patient was a 44 year old woman with unequivocal hypoadrenalism(5). The only uncertainty was whether hypoadrenalism primary or secondary(5). Accordingly, at the very least, the work-up of recurrent pericarditis should include evaluation for coeliac disease and evaluation for endocrinopathy.
  I have no funding, and no conflict of interest.
  References
  (1)Cacoub P., Marques C
  Acute recurrent pericarditis: from pathophysiology towards new treatment strategy
  Heart doi: 10.1136/heartjnl-2019-316481
  (2)Faizallah R., Costello FC., Lee FI., Walker R
  Adult celiac disease and recurrent pericarditis
  Digestive Diseases and Sciences 1982;27:728-730
  *3)Laine LA., Holt KM
  Recurrent pericarditis and celiac disease
  JAMA 1984;252:doi:10.100/jama.1984.03350220074036
  (4)Tucker WS., Niblack GD., McLean RH et al
  Serositis with autoimmune endocrinopathy: Clinical and Immunogenetic features
  Medicine 1987;66:138-147
  (5)Manthri S., Bandaru S., Ibrahim A., Mamillapalli C
  Acute pericarditis as a presentation of adrenal insufficiency
  Cureus 2018;10;e2474 DOI 10.7759/cureus 2474

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  Conflict of Interest:
  None declared.

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