Acute Pericarditis After Percutaneous Coronary Intervention

Pericarditis may be a complication of percutaneous coronary intervention (PCI), and should be considered as a differential for persistent chest pain following a PCI.  In this report, we present a male in his 60s, who developed pericarditis after a primary PCI for an anterior ST elevation myocardial infarction (STEMI). He had an uncomplicated PCI to left anterior descending artery, and was discharged as per standard procedure 48 hours post-procedure. On that same evening, the patient re-presented to hospital with different chest pain and fever. Electrocardiogram (ECG) revealed anterior ST elevation.  A provisional diagnosis of pericarditis was made in view of elevated inflammatory markers, a recent Mycoplasma infection with fevers, positron emission tomography-computed tomography (PET-CT) findings, as well as pericardial chest pain. A three-month course of colchicine was initiated. Two weeks after discharge, he was readmitted with non-resolving fevers. Echocardiogram (ECHO) and CT thorax revealed a 26mm pericardial effusion. This was not drained, as he had no signs of tamponade. He was treated as possible infective pericarditis with intravenous (IV) teicoplanin and piperacillin-tazobactam, which was stepped down to oral co-trimoxazole on discharge. Three weeks after completing the oral antibiotics, he was re-admitted again with fevers and chest pain. He was restarted on antibiotics and heart failure medications were up-titrated. He was continued on colchicine and started on ibuprofen. Due to the recurrent episodes of pericarditis, he was also commenced on a weaning course of prednisolone. The patient's symptoms subsequently improved after treatment, and he is awaiting follow-up with his Cardiologist, alongside a repeat ECHO prior to the appointment.