The return of a disappearing entity: Dressler's syndrome after transvenous pacemaker implantation

Area of Science:

• Cardiology
• Internal Medicine
• Medical Complications

Background:

• A 76-year-old woman with idiopathic dilated cardiomyopathy and left bundle branch block underwent biventricular pacemaker implantation.
• The procedure was complicated by coronary sinus tributary vein perforation, leading to pericardial effusion without tamponade.

Observation:

• Three months post-procedure, the patient presented with fever, pleuritic chest pain, and worsening functional class.
• Clinical examination revealed new pericardial and pleural effusions.
• Blood and pleural fluid cultures were sterile, and the patient did not respond to antibiotic therapy.

Findings:

• A Dressler-like syndrome was hypothesized as the cause of the effusions.
• The patient showed clinical improvement following a short course of steroid therapy.
• Discharge on colchicine resulted in complete remission of pleural effusion within two months, as confirmed by chest X-ray.

Implications:

• This case highlights a rare post-procedural complication mimicking Dressler's syndrome.
• It underscores the importance of considering inflammatory post-pericardiotomy syndromes in patients with unexplained effusions after cardiac procedures.
• Successful management with steroids and colchicine suggests these agents may be effective in similar cases.