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[Cholesterol pericarditis associated with rheumatoid arthritis].
Harefuah
|March 13, 2001
Summary
Cholesterol pericarditis, a rare condition causing chronic pericardial effusion with high cholesterol, can be linked to rheumatoid arthritis. This case highlights a patient with rheumatoid arthritis who developed cholesterol pericarditis, responding well to treatment.
Area of Science:
- Cardiology
- Rheumatology
- Pathology
Background:
- Cholesterol pericarditis (CP) is a rare condition characterized by chronic pericardial effusion with elevated cholesterol levels.
- It can lead to inflammation and constrictive pericarditis due to cholesterol crystal precipitation.
- CP is often associated with systemic diseases, including rheumatoid arthritis (RA).
Observation:
- A 78-year-old woman with established RA presented with dyspnea and weakness.
- Echocardiography revealed a large pericardial effusion.
- Analysis of the pericardial fluid showed high cholesterol and triglyceride levels, with numerous cholesterol crystals, and a characteristic 'gold-paint' appearance.
Findings:
- The pericardial fluid cholesterol concentration was significantly elevated at 264 mg/dl.
- Microscopic examination confirmed the presence of abundant cholesterol crystals.
- Infectious and other systemic causes were ruled out, supporting a diagnosis of CP secondary to RA.
Implications:
- This case underscores the association between rheumatoid arthritis and cholesterol pericarditis.
- Understanding the mechanisms of cholesterol accumulation in the pericardial space is crucial.
- Effective management involves addressing the underlying systemic disease and pericardial effusion, as demonstrated by the patient's positive response to methotrexate and steroids.