Recurrent Pericarditis in a Patient With Ankylosing Spondylitis: A Report of a Rare Case

Only a small subset of patients with ankylosing spondylitis (AS) develop cardiac complications, and pericardial inflammation is particularly uncommon. We report a 31-year-old human leukocyte antigen B27 (HLA-B27)-positive man with AS diagnosed in 2018 who, after discontinuing golimumab in 2021, experienced two episodes of acute pericarditis in 2025. In March, he presented with fever and chest pain. The electrocardiogram (ECG) showed diffuse, mild concave ST-segment elevation; chest computed tomography (CT) demonstrated a circumferential pericardial effusion measuring 24 mm with bilateral pleural effusions, consistent with polyserositis, and transthoracic echocardiography (TTE) confirmed a 15-17 mm fibrinous effusion without tamponade. He improved with colchicine and a corticosteroid taper. In August, he returned with pleuritic chest pain; the ECG revealed sinus tachycardia with diffuse ST elevation and PR-segment depression, and echocardiography showed a thin residual effusion. Bacterial and viral infections (including multiplex testing for respiratory and enteroviral pathogens and serology for cytomegalovirus, Epstein-Barr virus, and parvovirus B19), HIV, hepatitis B and C, and autoimmune causes were systematically excluded, and there were no clinical or imaging features to suggest malignancy. Taken together, the relapse and overall context favored attribution to AS-related inflammation. This case underscores the need to keep pericarditis in mind when patients with AS present with chest pain and to align pericarditis therapy with control of the underlying disease.