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Lack of efficacy: case report A 23-year-old man exhibited lack of efficacy during treatment with ibuprofen, colchicine and prednisolone for idiopathic acute pericarditis. The man, who had a history of childhood asthma, idiopathic episcleritis, non-allergic rhinitis, and septic shock complicating tonsillitis one month previously, presented with a low grade fever and retrosternal chest pain for 3 days. The next day, he developed cardiac tamponade and underwent pericardiocentesis. However, he progressed to profound shock, required noradrenaline dose. Then, he was treated with methylprednisolone with good clinical response. Pericardial fluid revealed the presence of Streptococcus mitis and he received ceftriaxone treatment. A working diagnosis of idiopathic acute pericarditis was made and he was discharged on ibuprofen 600mg 3 times a day, prednisolone 5mg once a day and colchicine 0.5mg once daily [routes not stated]. However, he was re-hospitalised after 4 weeks due to incessant pericarditis with cardiac tamponade, which needed immediate pericardiocentesis. He was then discharged on methylprednisolone. The symptoms recurred when the methylprednisolone dose was tapered, and led to several re-hospitalisations. During the third readmission, he developed hyponatraemia and hyperkalaemia led to the suspicion of adrenal insufficiency. Based on adrenal axis measurements, a diagnosis of Addison’s disease was made. He received treatment with fludrocortisone and prednisolone. Further evaluation revealed the presence of primary hypogonadism and anti-intrinsic factor autoantibodies. Based on these findings, a diagnosis of autoimmune polyglandular syndrome type 2 was made. It was considered that the incessant pericarditis and cardiac tamponade were the manifestations of autoimmune polyglandular syndrome type 2. Marinho AV, et al. Incessant Pericarditis With Recurrent Cardiac Tamponade as the Manifestation of Autoimmune Polyglandular Syndrome Type II. JACC: Case Reports 2: 803506996 1536-1541, No. 10, Aug 2020. Available from: URL: http://doi.org/10.1016/j.jaccas.2020.05.083

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Reactions 17 Oct 2020 No. 1826