https://orcid.org/0000-0002-0573-464X
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Salvatore De Vita, Marzia De Biasio, Alen Zabotti, Giorgio Morocutti, Luca Quartuccio, Ginevra De Marchi, Alessandro Proclemer, Successful treatment of complicated pericarditis after myocardial infarction with interleukin-1 blocker, Rheumatology, Volume 59, Issue 2, February 2020, Pages 445–447, https://doi.org/10.1093/rheumatology/kez307
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Sir, We report the case of a 66-year-old man admitted to the Coronary Care Unit of the Santa Maria della Misericordia Hospital of Udine, Italy, for subacute inferior-posterior myocardial infarction, and later developing a complicated pericarditis and severe systemic inflammation. The patient had a negligible medical history, except for a right hip replacement 2 months before.
The day before admission, a new onset of chest discomfort was recorded. The following day during a cardiologic evaluation ECG showed inferior Q waves and a small r wave in V1 with persistent ST-elevation, and T wave inversion in the inferior and in V5-V6 leads (Fig. 1), consistent with recent myocardial infarction. The transthoracic echocardiogram confirmed inferior and posterior walls akinesia with preserved global systolic function and mild pericardial effusion without signs of tamponade. Invasive coronary angiography was performed and demonstrated an occlusion of a posterolateral coronary branch and a critical stenosis of the proximal circumflex artery, which was treated by percutaneous transluminal coronary angioplasty with drug-eluting stent. During the following days a growing pericardial and pleural effusion occurred, with high grade fever (up to 39.5°C) and severe systemic inflammation (CRP 28, 5 mg/dl, procalcitonin 0.53 ng/ml). Autoimmunity (ANA, anti-dsDNA, ENA, RF, ACPA and ANCA), anti-phospholipid antibodies and microbiological analyses (including blood haemocultures) were all negative, and empirical therapy with high doses of acetylsalicylic acid (i.e. 1000 mg daily) plus antimicrobial therapy with levofloxacin and piperacillin/tazobactam were administered, however without any benefit.
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