Rheumatoid Arthritis and Cardiac Compression Caused by a Large Fibrotic Intrapericardial Mass and Effusion: A Case Report
Identifieur interne : 000850 ( Ncbi/Merge ); précédent : 000849; suivant : 000851Rheumatoid Arthritis and Cardiac Compression Caused by a Large Fibrotic Intrapericardial Mass and Effusion: A Case Report
Auteurs : Kazue Okajima [États-Unis] ; Therese Posas-Mendoza [États-Unis] ; Diane D. Tran [États-Unis] ; Robert A. Hong [États-Unis]Source :
- The American Journal of Case Reports [ 1941-5923 ] ; 2019.
Abstract
Pericarditis is common in rheumatoid arthritis, mostly occurring as an extra-articular manifestation of the disease. We describe a patient with stable rheumatoid arthritis who presented with a large pericardial effusion and a compressive fibrotic pericardial mass. The patient had recently started treatment with a tumor necrosis factor-alpha (TNF-α) antagonist.
The patient was a 58-year-old woman with rheumatoid arthritis who presented with right ventricular compression caused by a pericardial fibrotic mass and a large pericardial effusion. The patient did not have active arthritis at the time of presentation. She had been started on treatment with a tumor necrosis factor-alpha (TNF-α) antagonist 4 months prior to this presentation. She was successfully treated with surgical pericardiectomy and resection of the pericardial mass. Pathologic analysis of the pericardial mass demonstrated fibrosis and no evidence of active inflammation, rheumatoid arthritis, opportunistic infection, or malignancy.
We describe a patient with stable rheumatoid arthritis who developed subacute right heart compression syndrome secondary to pericardial effusion and fibrous pericardial mass. The exact cause of pericarditis and the pericardial mass remain uncertain. There is a need for increased awareness of the association between use of TNF-α antagonists and the possible development of an intrapericardial fibrotic mass and effusion.
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DOI: 10.12659/AJCR.916491
PubMed: 31353363
PubMed Central: 6683306
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Burns School of Medicine, Honolulu, HI</wicri:regionArea><wicri:noRegion>HI</wicri:noRegion></affiliation></author><author><name sortKey="Posas Mendoza, Therese" sort="Posas Mendoza, Therese" uniqKey="Posas Mendoza T" first="Therese" last="Posas-Mendoza">Therese Posas-Mendoza</name><affiliation wicri:level="1"><nlm:aff id="af2-amjcaserep-20-1120">Department of Internal Medicine, University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, U.S.A.</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Internal Medicine, University of Hawaii, John A. Burns School of Medicine, Honolulu, HI</wicri:regionArea><wicri:noRegion>HI</wicri:noRegion></affiliation></author><author><name sortKey="Tran, Diane D" sort="Tran, Diane D" uniqKey="Tran D" first="Diane D." last="Tran">Diane D. Tran</name><affiliation wicri:level="1"><nlm:aff id="af3-amjcaserep-20-1120">Department of Cardiology, Queens Medical Center, Honolulu, HI, U.S.A.</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Cardiology, Queens Medical Center, Honolulu, HI</wicri:regionArea><wicri:noRegion>HI</wicri:noRegion></affiliation></author><author><name sortKey="Hong, Robert A" sort="Hong, Robert A" uniqKey="Hong R" first="Robert A." last="Hong">Robert A. Hong</name><affiliation wicri:level="1"><nlm:aff id="af3-amjcaserep-20-1120">Department of Cardiology, Queens Medical Center, Honolulu, HI, U.S.A.</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Cardiology, Queens Medical Center, Honolulu, HI</wicri:regionArea><wicri:noRegion>HI</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">31353363</idno><idno type="pmc">6683306</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683306</idno><idno type="RBID">PMC:6683306</idno><idno type="doi">10.12659/AJCR.916491</idno><date when="2019">2019</date><idno type="wicri:Area/Pmc/Corpus">000403</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000403</idno><idno type="wicri:Area/Pmc/Curation">000403</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000403</idno><idno type="wicri:Area/Pmc/Checkpoint">000417</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000417</idno><idno type="wicri:Area/Ncbi/Merge">000850</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Rheumatoid Arthritis and Cardiac Compression Caused by a Large Fibrotic Intrapericardial Mass and Effusion: A Case Report</title><author><name sortKey="Okajima, Kazue" sort="Okajima, Kazue" uniqKey="Okajima K" first="Kazue" last="Okajima">Kazue Okajima</name><affiliation wicri:level="1"><nlm:aff id="af1-amjcaserep-20-1120">Department of Cardiology, University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, U.S.A.</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Cardiology, University of Hawaii, John A. Burns School of Medicine, Honolulu, HI</wicri:regionArea><wicri:noRegion>HI</wicri:noRegion></affiliation></author><author><name sortKey="Posas Mendoza, Therese" sort="Posas Mendoza, Therese" uniqKey="Posas Mendoza T" first="Therese" last="Posas-Mendoza">Therese Posas-Mendoza</name><affiliation wicri:level="1"><nlm:aff id="af2-amjcaserep-20-1120">Department of Internal Medicine, University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, U.S.A.</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Internal Medicine, University of Hawaii, John A. Burns School of Medicine, Honolulu, HI</wicri:regionArea><wicri:noRegion>HI</wicri:noRegion></affiliation></author><author><name sortKey="Tran, Diane D" sort="Tran, Diane D" uniqKey="Tran D" first="Diane D." last="Tran">Diane D. Tran</name><affiliation wicri:level="1"><nlm:aff id="af3-amjcaserep-20-1120">Department of Cardiology, Queens Medical Center, Honolulu, HI, U.S.A.</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Cardiology, Queens Medical Center, Honolulu, HI</wicri:regionArea><wicri:noRegion>HI</wicri:noRegion></affiliation></author><author><name sortKey="Hong, Robert A" sort="Hong, Robert A" uniqKey="Hong R" first="Robert A." last="Hong">Robert A. Hong</name><affiliation wicri:level="1"><nlm:aff id="af3-amjcaserep-20-1120">Department of Cardiology, Queens Medical Center, Honolulu, HI, U.S.A.</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Cardiology, Queens Medical Center, Honolulu, HI</wicri:regionArea><wicri:noRegion>HI</wicri:noRegion></affiliation></author></analytic><series><title level="j">The American Journal of Case Reports</title><idno type="eISSN">1941-5923</idno><imprint><date when="2019">2019</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><bold>Patient: Female, 58</bold></p><p><bold>Final Diagnosis: Pericardial effusion and mass</bold></p><p><bold>Symptoms: Fatigue • lower extremity edema • shortness of breath</bold></p><p><bold>Medication: —</bold></p><p><bold>Clinical Procedure: Pericardiocentesis</bold></p><p><bold>Specialty: Rheumatology</bold></p><sec><title>Objective:</title><p><bold>Unknown ethiology</bold></p></sec><sec><title>Background:</title><p>Pericarditis is common in rheumatoid arthritis, mostly occurring as an extra-articular manifestation of the disease. We describe a patient with stable rheumatoid arthritis who presented with a large pericardial effusion and a compressive fibrotic pericardial mass. The patient had recently started treatment with a tumor necrosis factor-alpha (TNF-α) antagonist.</p></sec><sec><title>Case Report:</title><p>The patient was a 58-year-old woman with rheumatoid arthritis who presented with right ventricular compression caused by a pericardial fibrotic mass and a large pericardial effusion. The patient did not have active arthritis at the time of presentation. She had been started on treatment with a tumor necrosis factor-alpha (TNF-α) antagonist 4 months prior to this presentation. She was successfully treated with surgical pericardiectomy and resection of the pericardial mass. Pathologic analysis of the pericardial mass demonstrated fibrosis and no evidence of active inflammation, rheumatoid arthritis, opportunistic infection, or malignancy.</p></sec><sec><title>Conclusions:</title><p>We describe a patient with stable rheumatoid arthritis who developed subacute right heart compression syndrome secondary to pericardial effusion and fibrous pericardial mass. The exact cause of pericarditis and the pericardial mass remain uncertain. There is a need for increased awareness of the association between use of TNF-α antagonists and the possible development of an intrapericardial fibrotic mass and effusion.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Voskuyl, Ae" uniqKey="Voskuyl A">AE Voskuyl</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Corrao, S" uniqKey="Corrao S">S Corrao</name></author><author><name sortKey="Messina, S" uniqKey="Messina S">S Messina</name></author><author><name sortKey="Pistone, G" uniqKey="Pistone G">G Pistone</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Al Ani, M" uniqKey="Al Ani M">M Al-Ani</name></author><author><name sortKey="Weber, M" uniqKey="Weber M">M Weber</name></author><author><name sortKey="Winchester, D" uniqKey="Winchester D">D Winchester</name></author><author><name sortKey="Kosboth, M" uniqKey="Kosboth M">M Kosboth</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bhat, P" uniqKey="Bhat P">P Bhat</name></author><author><name sortKey="Chandrasekaran, B" uniqKey="Chandrasekaran B">B Chandrasekaran</name></author><author><name sortKey="Barnes, E" uniqKey="Barnes E">E Barnes</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rodriguez Monserrate, Cp" uniqKey="Rodriguez Monserrate C">CP Rodriguez Monserrate</name></author><author><name sortKey="Del Rio, Jr" uniqKey="Del Rio J">JR del Rio</name></author><author><name sortKey="Lopez Lopez, Y" uniqKey="Lopez Lopez Y">Y Lopez Lopez</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Soh, Mc" uniqKey="Soh M">MC Soh</name></author><author><name sortKey="Hart, Hh" uniqKey="Hart H">HH Hart</name></author><author><name sortKey="Corkill, M" uniqKey="Corkill M">M Corkill</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ozkan, H" uniqKey="Ozkan H">H Ozkan</name></author><author><name sortKey="Cetinkaya, As" uniqKey="Cetinkaya A">AS Cetinkaya</name></author><author><name sortKey="Yildiz, T" uniqKey="Yildiz T">T Yildiz</name></author><author><name sortKey="Bozat, T" uniqKey="Bozat T">T Bozat</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Edwards, Mh" uniqKey="Edwards M">MH Edwards</name></author><author><name sortKey="Leak, Am" uniqKey="Leak A">AM Leak</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lather, Hd" uniqKey="Lather H">HD Lather</name></author><author><name sortKey="Kahlenberg, Jm" uniqKey="Kahlenberg J">JM Kahlenberg</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Distler, Jh" uniqKey="Distler J">JH Distler</name></author><author><name sortKey="Schett, G" uniqKey="Schett G">G Schett</name></author><author><name sortKey="Gay, S" uniqKey="Gay S">S Gay</name></author><author><name sortKey="Distler, O" uniqKey="Distler O">O Distler</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yoshikawa, Gt" uniqKey="Yoshikawa G">GT Yoshikawa</name></author><author><name sortKey="Dias, Ga" uniqKey="Dias G">GA Dias</name></author><author><name sortKey="Fujihara, S" uniqKey="Fujihara S">S Fujihara</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Am J Case Rep</journal-id><journal-id journal-id-type="iso-abbrev">Am J Case Rep</journal-id><journal-id journal-id-type="publisher-id">amjcaserep</journal-id><journal-title-group><journal-title>The American Journal of Case Reports</journal-title></journal-title-group><issn pub-type="epub">1941-5923</issn><publisher><publisher-name>International Scientific Literature, Inc.</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">31353363</article-id><article-id pub-id-type="pmc">6683306</article-id><article-id pub-id-type="doi">10.12659/AJCR.916491</article-id><article-id pub-id-type="publisher-id">916491</article-id><article-categories><subj-group subj-group-type="heading"><subject>Articles</subject></subj-group></article-categories><title-group><article-title>Rheumatoid Arthritis and Cardiac Compression Caused by a Large Fibrotic Intrapericardial Mass and Effusion: A Case Report</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Okajima</surname><given-names>Kazue</given-names></name><xref ref-type="author-notes" rid="fn1-amjcaserep-20-1120"><sup>A</sup></xref><xref ref-type="author-notes" rid="fn6-amjcaserep-20-1120"><sup>F</sup></xref><xref ref-type="aff" rid="af1-amjcaserep-20-1120"><sup>1</sup></xref><xref ref-type="corresp" rid="c1-amjcaserep-20-1120"></xref></contrib><contrib contrib-type="author"><name><surname>Posas-Mendoza</surname><given-names>Therese</given-names></name><xref ref-type="author-notes" rid="fn5-amjcaserep-20-1120"><sup>E</sup></xref><xref ref-type="aff" rid="af2-amjcaserep-20-1120"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Tran</surname><given-names>Diane D.</given-names></name><xref ref-type="author-notes" rid="fn1-amjcaserep-20-1120"><sup>A</sup></xref><xref ref-type="aff" rid="af3-amjcaserep-20-1120"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Hong</surname><given-names>Robert A.</given-names></name><xref ref-type="author-notes" rid="fn1-amjcaserep-20-1120"><sup>A</sup></xref><xref ref-type="author-notes" rid="fn6-amjcaserep-20-1120"><sup>F</sup></xref><xref ref-type="aff" rid="af3-amjcaserep-20-1120"><sup>3</sup></xref></contrib></contrib-group><aff id="af1-amjcaserep-20-1120"><label>1</label>Department of Cardiology, University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, U.S.A.</aff><aff id="af2-amjcaserep-20-1120"><label>2</label>Department of Internal Medicine, University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, U.S.A.</aff><aff id="af3-amjcaserep-20-1120"><label>3</label>Department of Cardiology, Queens Medical Center, Honolulu, HI, U.S.A.</aff><author-notes><fn><p>Authors’ Contribution:</p></fn><fn id="fn1-amjcaserep-20-1120"><label>A</label><p>Study Design</p></fn><fn id="fn2-amjcaserep-20-1120"><label>B</label><p>Data Collection</p></fn><fn id="fn3-amjcaserep-20-1120"><label>C</label><p>Statistical Analysis</p></fn><fn id="fn4-amjcaserep-20-1120"><label>D</label><p>Data Interpretation</p></fn><fn id="fn5-amjcaserep-20-1120"><label>E</label><p>Manuscript Preparation</p></fn><fn id="fn6-amjcaserep-20-1120"><label>F</label><p>Literature Search</p></fn><fn id="fn7-amjcaserep-20-1120"><label>G</label><p>Funds Collection</p></fn><fn fn-type="COI-statement"><p><bold>Conflict of interest:</bold> None declared</p></fn><corresp id="c1-amjcaserep-20-1120">Corresponding Author: Kazue Okajima, e-mail: <email>kokajima@hawaii.edu</email></corresp></author-notes><pub-date pub-type="collection"><year>2019</year></pub-date><pub-date pub-type="epub"><day>29</day><month>7</month><year>2019</year></pub-date><volume>20</volume><fpage>1120</fpage><lpage>1123</lpage><history><date date-type="received"><day>25</day><month>3</month><year>2019</year></date><date date-type="accepted"><day>21</day><month>5</month><year>2019</year></date></history><permissions><copyright-statement>© Am J Case Rep, 2019</copyright-statement><copyright-year>2019</copyright-year><license license-type="open-access"><license-p>This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (<ext-link ext-link-type="uri" xlink:href="https://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND 4.0</ext-link>)</license-p></license></permissions><abstract><p><bold>Patient: Female, 58</bold></p><p><bold>Final Diagnosis: Pericardial effusion and mass</bold></p><p><bold>Symptoms: Fatigue • lower extremity edema • shortness of breath</bold></p><p><bold>Medication: —</bold></p><p><bold>Clinical Procedure: Pericardiocentesis</bold></p><p><bold>Specialty: Rheumatology</bold></p><sec><title>Objective:</title><p><bold>Unknown ethiology</bold></p></sec><sec><title>Background:</title><p>Pericarditis is common in rheumatoid arthritis, mostly occurring as an extra-articular manifestation of the disease. We describe a patient with stable rheumatoid arthritis who presented with a large pericardial effusion and a compressive fibrotic pericardial mass. The patient had recently started treatment with a tumor necrosis factor-alpha (TNF-α) antagonist.</p></sec><sec><title>Case Report:</title><p>The patient was a 58-year-old woman with rheumatoid arthritis who presented with right ventricular compression caused by a pericardial fibrotic mass and a large pericardial effusion. The patient did not have active arthritis at the time of presentation. She had been started on treatment with a tumor necrosis factor-alpha (TNF-α) antagonist 4 months prior to this presentation. She was successfully treated with surgical pericardiectomy and resection of the pericardial mass. Pathologic analysis of the pericardial mass demonstrated fibrosis and no evidence of active inflammation, rheumatoid arthritis, opportunistic infection, or malignancy.</p></sec><sec><title>Conclusions:</title><p>We describe a patient with stable rheumatoid arthritis who developed subacute right heart compression syndrome secondary to pericardial effusion and fibrous pericardial mass. The exact cause of pericarditis and the pericardial mass remain uncertain. There is a need for increased awareness of the association between use of TNF-α antagonists and the possible development of an intrapericardial fibrotic mass and effusion.</p></sec></abstract><kwd-group><title>MeSH Keywords:</title><kwd>Antirheumatic Agents</kwd><kwd>Pericardial Effusion</kwd><kwd>Pericardiectomy</kwd><kwd>Tumor Necrosis Factor-alpha</kwd></kwd-group></article-meta></front><floats-group><fig id="f1-amjcaserep-20-1120" position="float"><label>Figure 1.</label><caption><p>Echocardiogram. Subcostal view demonstrating large pericardial effusion and a mass (arrow) compressing the right ventricle. PE – pericardial effusion; RA – right atrium; RV – right ventricle; LV – left ventricle; LA – left atrium.</p></caption><graphic xlink:href="amjcaserep-20-1120-g001"></graphic></fig><fig id="f2-amjcaserep-20-1120" position="float"><label>Figure 2.</label><caption><p>Cardiac magnetic resonance imaging. (<bold>A</bold>) T-1 weighted, demonstrates isointense soft mass measuring in the pericardial sac compressing right ventricle. (<bold>B</bold>) T-2 weighted demonstrated the mass with T2 hyper intensity. (<bold>C</bold>) Late gadolinium enhancement demonstrates intense enhancement in the pericardium and part of the soft tissue mass.</p></caption><graphic xlink:href="amjcaserep-20-1120-g002"></graphic></fig><fig id="f3-amjcaserep-20-1120" position="float"><label>Figure 3.</label><caption><p>Histology (hematoxylineosin stain). (<bold>A</bold>) Intrapericardial mass, acellular fibrinous material with entrapped red blood cell (magnification ×4). (<bold>B</bold>) Intrapericardial mass (magnification ×40). (<bold>C</bold>) Pericardium. Thickened, fibrotic pericardium with chronic inflammation and granulation tissue (magnification ×4). (<bold>D</bold>) Pericardium (magnification ×40).</p></caption><graphic xlink:href="amjcaserep-20-1120-g003"></graphic></fig></floats-group></pmc><affiliations><list><country><li>États-Unis</li></country></list><tree><country name="États-Unis"><noRegion><name sortKey="Okajima, Kazue" sort="Okajima, Kazue" uniqKey="Okajima K" first="Kazue" last="Okajima">Kazue Okajima</name></noRegion><name sortKey="Hong, Robert A" sort="Hong, Robert A" uniqKey="Hong R" first="Robert A." last="Hong">Robert A. Hong</name><name sortKey="Posas Mendoza, Therese" sort="Posas Mendoza, Therese" uniqKey="Posas Mendoza T" first="Therese" last="Posas-Mendoza">Therese Posas-Mendoza</name><name sortKey="Tran, Diane D" sort="Tran, Diane D" uniqKey="Tran D" first="Diane D." last="Tran">Diane D. Tran</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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