[ link to online video2: https://youtu.be/RuhrhXOoqmw
]
Video 2: TTE imaging results: pericardial thickening
is demonstrated
All of the TTE imaging results mentioned above, were in favor of acute
fibrinous pericarditis with constrictive features. Abdominal
ultrasonography was performed to assess any evidence of malignancy and
the result was clear. Laboratory investigations revealed mild
leukocytosis with 14850 white blood cell per microliter, elevated
C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR)
(Table 1). Tuberculin skin test with purified protein derivative (PPD)
was performed and the result turned out to be negative (Table 1). Viral
screening test results were also negative. Mycobacterium tuberculosis
(TB), and other probable infectious diseases were ruled out (Table 1).
We started pericarditis treatment with anti-inflammatory agents of oral
ibuprofen 600 mg every 8 hours (q8h) and colchicine 0.5 mg daily (q24h)
while continuing our investigations for immune-mediated inflammatory
processes as a probable cause.
Our patient was on the treatment protocol of ibuprofen and colchicine
for 1 week with no significant improvement of his signs and symptoms or
TTE examination. Therefore, after one week from his admission,
corticosteroids were added to our patient’s treatment regimen with the
starting dose of 30 mg prednisolone daily; 60 kg * 0.5 mg/kg/day.
Meanwhile, Investigations for autoimmune etiology revealed high titers
of anti-nuclear antibody (ANA) and rheumatoid factor (RF) with elevated
levels of anti-ds DNA antibody (Table 1). As anti-ds DNA anti-body is a
specific marker for SLE, we calculated our patient’s score for diagnosis
of SLE according to the 2019 European league against rheumatism (EULAR)
and the American college of rheumatology (ACR) classification criteria
for systemic lupus erythematosus [7]. Thus, rheumatologic consult
was ordered.
Table 1 . Laboratory findings.