Rheumatoid Arthritis and Cardiac Compression Caused by a Large Fibrotic Intrapericardial Mass and Effusion: A Case...

Area of Science:

• Cardiology
• Rheumatology
• Oncology

Background:

• Pericarditis is a known extra-articular manifestation in rheumatoid arthritis.
• Tumor necrosis factor-alpha (TNF-alpha) antagonists are commonly used to manage rheumatoid arthritis.
• The development of pericardial masses in conjunction with TNF-alpha antagonist therapy is rarely reported.

Observation:

• A 58-year-old woman with stable rheumatoid arthritis presented with a large pericardial effusion and a compressive fibrotic pericardial mass.
• The patient had initiated treatment with a TNF-alpha antagonist four months prior to presentation.
• The pericardial mass showed fibrosis without evidence of malignancy, infection, or active inflammation.

Findings:

• The patient experienced subacute right heart compression syndrome due to the pericardial effusion and mass.
• Surgical pericardiectomy and mass resection were successfully performed.
• The etiology of the pericarditis and fibrotic mass remains uncertain, but a link to TNF-alpha antagonist use is suspected.

Implications:

• Increased awareness of intrapericardial fibrotic masses and effusions associated with TNF-alpha antagonist use is warranted.
• This case highlights a potential, albeit rare, adverse effect of biologic therapy in rheumatoid arthritis.
• Further investigation may be needed to elucidate the exact mechanism linking TNF-alpha antagonists to pericardial pathology.