Abstract 13604: No Longer Idiopathic: A Case of Recurrent Pericarditis in a Military Recruit
A 19 year-old man who is a military cadet and also a competitive gymnast presented during boot camp with one week of progressive chest pain and shortness of breath associated with fevers, malaise, and myalgias. He reported similar episodes twice yearly for the past five years, always coinciding with stressful events (sports competitions, military responsibilities). Previously, he self-treated with naproxen but now the episodes occurred as frequently as every three months. His initial electrocardiogram showed diffuse ST-segment elevations and an echocardiogram revealed a large circumferential pericardial effusion. Laboratory analysis was notable for leukocytosis, elevated inflammatory markers, and negative cardiac biomarkers. A diagnostic and therapeutic pericardiocentesis yielded 800cc of exudative fluid and initial work-up for infectious and neoplastic processes was unrevealing. He was discharged home to Boston on analgesics to control his chest pain but then presented to our hospital with recurrent chest symptoms and ongoing fevers. Repeat echocardiogram was notable for pericardial thickening and fibrinous material in the pericardial space but without a pericardial effusion. Chest imaging demonstrated only small bilateral pleural effusions. A more extensive infectious and rheumatologic laboratory evaluation was unrevealing. Given his discrete recurrent febrile syndromes with clinical serositis occurring, Familial Mediterranean Fever was suspected. Pericardial and pleural biopsies confirmed evidence of acute and chronic inflammation. Genetic testing for periodic fever syndromes yielded a mutation in the MEFV gene supporting the clinical diagnosis of Familial Mediterranean Fever. His chest pain was successfully treated with a tapered course of high-dose non-steroidal anti-inflammatory agents and colchicine. Familial Mediterranean Fever is an autosomal recessive disorder characterized by recurrent attacks of fever and serositis with excellent response to colchicine therapy. Pericarditis is a rare, but treatable, manifestation of this uncommon disease. With ongoing colchicine therapy, he has returned to his military academy and to competitive gymnastics.
- © 2012 by American Heart Association, Inc.