Egwu Chinelo, Scullion Malo, Gingles Christopher, Kerrigan Sean
Cardiology Department, Forth Valley Royal Hospital, Larbert FK5 4WR, UK.
Rheumatology Department, Forth Valley Royal Hospital, Larbert FK5 4WR, UK.
Eur Heart J Case Rep. 2024 Aug 19;8(9):ytae428. doi: 10.1093/ehjcr/ytae428. eCollection 2024 Sep.
We report an unusual case of rheumatoid arthritis presenting for the first time with pericardial constriction and bilateral pleural calcification, in the absence of prior articular disease.
A 46-year-old Caucasian male, who initially presented with shortness of breath, intermittent chest tightness and general malaise, underwent extensive diagnostic workup over a period of six months involving multiple hospital admissions. He was found to have pericardial constriction on echocardiogram and ultimately required surgical pericardiectomy due to decompensation. After multiple diagnostic tests and specialist opinion, the aetiology of pericardial disease was ultimately confirmed to be extra-articular rheumatoid disease without synovitis.
Significant pericardial constriction can occur as the initial presentation of rheumatoid disease and anti-CCP is a highly specific confirmatory test. Pericardial pathological specimen can be unhelpful in determining this aetiology, and constrictive physiology can occur due to chronic inflammation/fibrosis in the absence of significant calcification.
我们报告一例罕见的类风湿关节炎病例，首次表现为心包缩窄和双侧胸膜钙化，且既往无关节疾病史。
一名46岁的白种男性，最初表现为气短、间歇性胸闷和全身不适，在6个月的时间里多次住院接受了广泛的诊断检查。超声心动图检查发现他有心包缩窄，最终因失代偿而需要进行心包切除术。经过多项诊断测试和专家会诊，心包疾病的病因最终被确认为无滑膜炎的关节外类风湿病。
严重的心包缩窄可能是类风湿病的首发表现，抗环瓜氨酸肽抗体是一项高度特异性的确诊检查。心包病理标本对确定病因可能没有帮助，在没有明显钙化的情况下，慢性炎症/纤维化也可能导致缩窄性生理改变。
