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Disorders of the Pleura |

An Interesting Case of Postpericardiotomy Syndrome

Arvind Kalyan Sundaram, MBBS; Patrick Gordan, MD; Robert Campbell, MD; Vladamir Birjinuik, MD
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Mount Auburn Hospital, Cambridge, MA


Chest. 2014;146(4_MeetingAbstracts):480A. doi:10.1378/chest.1993912
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Abstract

SESSION TITLE: Pleural Student/Resident Case Report Posters

SESSION TYPE: Medical Student/Resident Case Report

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: Post-pericardiotomy syndrome (PPS) is a common complication following cardio-thoracic surgery (CTS). Studies have shown Colchicine to be effective for the prevention of PPS. Although available, there are less data for the treatment of PPS with Colchicine. We present a case of a patient diagnosed with PPS who had persistent symptoms necessitating treatment with Colchicine.

CASE PRESENTATION: A 43 year old man underwent surgical repair for a prolapsed mitral valve. He presented after the operation on multiple occasions with left lower back, left shoulder and right chest pain that improved upon bending forward. The physical exam was remarkable for diminished breath sounds at the left lung base. X-ray and CT-chest showed a left pleural effusion. The C-reactive protein was marginally elevated. Pleural fluid analysis was interpreted as an exudative effusion. Based on the history and work up, the patient was diagnosed with PPS. He was treated with Ibuprofen and tapering doses of Prednisone which relieved his symptoms for a short period of time with resolution of the left pleural effusion. However, he subsequently developed a recurrence of the initial symptoms and a repeat chest x-ray revealed a new small left pleural effusion. He was henceforth treated with Colchicine. Upon discontinuation of the Colchicine, his symptoms again returned. Ultimately his symptoms resolved after taking a prolonged course of Colchicine.

DISCUSSION: Post-pericardiotomy syndrome is a component of post-cardiac injury syndrome with an incidence rate of 10-40% following CTS. The etiopathogenesis of PPS is presumed to be of auto-immune origin. PPS can persist for many weeks to months and has a recurrence rate of 10-15%.1 Aspirin and other non-steroidal anti-inflammatory drugs are the primary treatment options. Corticosteroids are preferred to non-steroidal anti-inflammatory drugs when contraindications exist. Colchicine has been effectively used for the primary prevention and treatment of PPS and should be considered as a treatment option.2,3 Colchicine may be required for a prolonged period of time irrespective of symptom relief.

CONCLUSIONS: This case highlights the importance of considering Colchicine for PPS. Treatment with Colchicine may play a pivotal role in the prevention of recurrent distressing symptoms. We also emphasize the need for scrupulous compliance for prolonged periods despite clinical improvement. The proposed period of therapy currently for PPS with Colchicine is 3 months.3

Reference #1: Massimo, Et al. Post-cardiac injury syndromes. An emerging cause of pericardial diseases.Int J Cardiol.2013; 168(2):648-52.

Reference #2: Massimo, Et al. Colchicine for the Prevention of the Post-pericardiotomy Syndrome (COPPS): a multicentre, randomized, double-blind, placebo-controlled trial.Eur Heart J 2010; 31 (22): 2749-2754.

Reference #3: Eguchi, Et al. Colchicine as an effective treatment for postpericardiotomy syndrome following a lung lobectomy.Interact Cardiovasc Thorac Surg. 2010;11(6):869-71.

DISCLOSURE: The following authors have nothing to disclose: Arvind Kalyan Sundaram, Patrick Gordan, Robert Campbell, Vladamir Birjinuik

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