Ibrutinib-Induced Effusive Constrictive Pericarditis and Acute Atrial Fibrillation

Ibrutinib-associated pericardial disease is uncommon, and inflammatory effusive-constrictive pericarditis is rarely reported.

A 66-year-old man with recurrent chronic lymphocytic leukemia receiving ibrutinib presented with dyspnea and palpitations. Echocardiography showed a fibrinous circumferential pericardial effusion with constrictive physiology. Simultaneous right and left heart catheterization confirmed ventricular interdependence, and cardiac magnetic resonance imaging demonstrated diffuse pericardial late gadolinium enhancement consistent with active inflammation. He developed atrial fibrillation with rapid ventricular response. Ibrutinib was discontinued, and anti-inflammatory therapy, rate control, and anticoagulation were initiated. Follow-up imaging showed complete resolution of the effusion and constrictive physiology.

Multimodality imaging established the diagnosis and guided conservative management. Complete recovery after ibrutinib withdrawal and anti-inflammatory therapy supports a drug-related inflammatory mechanism and suggests that selected patients may avoid pericardiectomy.

Ibrutinib may rarely cause inflammatory effusive-constrictive pericarditis with atrial fibrillation. Multimodality imaging and multidisciplinary cardio-oncology care are critical for diagnosis and individualized management. Early recognition and medical therapy may reverse constrictive physiology and avoid pericardiectomy.