Idiopathic recurrent serositis-Off the beaten track.

Area of Science:

• Cardiology
• Rheumatology
• Internal Medicine

Background:

• Recurrent pleuropericardial effusions are rare and can be diagnostically challenging.
• Idiopathic recurrent serositis (IRS) is a diagnosis of exclusion, often presenting with inflammatory phenotypes.

Observation:

• A 63-year-old female presented with fever and chest pain due to recurrent pleuropericardial effusions.
• Extensive investigations ruled out infectious, autoimmune, and neoplastic causes, leading to an IRS diagnosis.
• The patient developed a rash to naproxen, a Nonsteroidal Anti-Inflammatory Drug (NSAID).

Findings:

• The patient responded well to colchicine monotherapy, which effectively managed her symptoms and prevented recurrence.
• Literature review highlights the rarity of pleuropericardial effusions and the diagnostic enigma they can present.
• This case demonstrates the efficacy of colchicine monotherapy in a patient with IRS intolerant to NSAIDs.

Implications:

• This case study proposes a diagnostic and management approach for pleuropericardial syndrome.
• It underscores the potential role of colchicine monotherapy in managing IRS, particularly in cases of NSAID intolerance.
• Highlights the importance of considering seronegative serositis in unexplained inflammatory effusions.