CONGRESS ABSTRACT

A 33-year-old smoker with autoimmune thyroiditis presented to the emergency department in July 2024 with dyspnea and generalized swelling, including pleural, ascitic, and pericardial effusions. Following a trip to Syria and Jordan in February, he experienced sharp chest pain without fever but did not seek medical help. His symptoms worsened over the months, leading to significant dyspnea and anasarca. Upon admission, blood tests showed mild inflammation (PCR 10). A CT scan revealed pericardial thickening and fluid effusions, along with bilateral pleural and abdominal effusions. The ECG showed sinus rhythm with low voltage and no significant ST-T changes. The cardiac ultrasound showed normal cardiac function but revealed abnormal respiratory displacement of the interventricular septum, a bounce during diastole, annulus paradoxus, and an abnormal flow pattern in the suprahepatic vein. These findings suggested constrictive pericarditis. A cardiac MRI revealed severe thickening and enhancement of the pericardial leaflets, indicating constriction and pathological ventricular interdependence, with no edema or late post-contrast enhancement in the myocardium observed. Cardiac catheterization confirmed constriction physiology. The patient was treated with a loop diuretic and thoracentesis with good response, and he underwent anterior pericardiectomy. Laboratory tests ruled out autoimmune and infectious etiologies of the disease, and the histological analysis of the pericardial specimen excluded neoplastic etiology. Post-surgery, due to persistent fever and elevated PCR, anti-inflammatory therapy with prednisone and colchicine was initiated. The patient was discharged in early September with ongoing cardio-active and anti-inflammatory therapy. Due to persistent high inflammatory markers (PCR 7), anti-inflammatory therapy was intensified by adding anakinra. Over the past few months, anti-inflammatory and cardioactive therapies have been reduced due to the patient’s stable condition and absence of signs of inflammation. Currently, the patient is asymptomatic with no active inflammation, treated with colchicine every other day and four ampoules of anakinra weekly. This case highlights the need to consider constrictive pericarditis in patients with unexplained heart failure symptoms. Early diagnosis and prompt intervention are crucial for better outcomes and postoperative anti-inflammatory therapy to manage ongoing inflammation and ensure stability.