Infliximab
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Effusive-constrictive pericarditis in an elderly patient: case report A 68-year-old woman developed effusive-constrictive pericarditis while receiving infliximab for rheumatoid arthritis (RA). The woman was admitted with right heart failure and massive pericardial effusion. After failing other RA therapies, she had been started on infliximab [route not stated and dosage not clearly stated]. Forty days after starting infliximab, and after the second dose (total dose 200mg), anorexia and leg oedema were exacerbated. Echocardiogram revealed that pericardial effusion had increased compared with prior to infliximab, and contained a fibrin-like echo. Physical examination showed that pericardial knock sound was absent, and pitting oedema was present in the lower extremities. Findings from right-sided cardiac catheterisation and pericardiocentesis indicated the haemodynamics of effusiveconstrictive pericarditis. Chest CT scan prior to pericardiocentesis demonstrated massive pericardial effusion and thickening of both pericardium and epicardium. The pericardial effusion markedly decreased after pericardiocentesis, but thickening of the pericardium and epicardium persisted. The pericardial fluid was bloody, but tested negative to microbial and cytological examinations. The possibility of an adverse effect of infliximab on rheumatic pericarditis was considered, and the woman’s infliximab administration was withdrawn. Her symptoms improved markedly following pericardiocentesis, and the pericardial effusion did not increase after infliximab was stopped. Author comment: "In our case, the association between exacerbation of pericarditis and infliximab is highly suspected through her clinical course. We decided to control her pericarditis by stopping the administration of infliximab, which was successful". Nakamura Y, et al. A case of effusive-constrictive pericarditis accompanying rheumatoid arthritis: The possibility of adverse effect of TNF-inhibitor therapy. Journal of Cardiology Cases 7: e8-e10, No. 1, Jan 2013. Available from: URL: 803083430 http://dx.doi.org/10.1016/j.jccase.2012.08.007 - Japan
0114-9954/10/1440-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 23 Feb 2013 No. 1440
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