[ link to online video2: https://youtu.be/RuhrhXOoqmw ]
Video 2: TTE imaging results: pericardial thickening is demonstrated
All of the TTE imaging results mentioned above, were in favor of acute fibrinous pericarditis with constrictive features. Abdominal ultrasonography was performed to assess any evidence of malignancy and the result was clear. Laboratory investigations revealed mild leukocytosis with 14850 white blood cell per microliter, elevated C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) (Table 1). Tuberculin skin test with purified protein derivative (PPD) was performed and the result turned out to be negative (Table 1). Viral screening test results were also negative. Mycobacterium tuberculosis (TB), and other probable infectious diseases were ruled out (Table 1). We started pericarditis treatment with anti-inflammatory agents of oral ibuprofen 600 mg every 8 hours (q8h) and colchicine 0.5 mg daily (q24h) while continuing our investigations for immune-mediated inflammatory processes as a probable cause.
Our patient was on the treatment protocol of ibuprofen and colchicine for 1 week with no significant improvement of his signs and symptoms or TTE examination. Therefore, after one week from his admission, corticosteroids were added to our patient’s treatment regimen with the starting dose of 30 mg prednisolone daily; 60 kg * 0.5 mg/kg/day.
Meanwhile, Investigations for autoimmune etiology revealed high titers of anti-nuclear antibody (ANA) and rheumatoid factor (RF) with elevated levels of anti-ds DNA antibody (Table 1). As anti-ds DNA anti-body is a specific marker for SLE, we calculated our patient’s score for diagnosis of SLE according to the 2019 European league against rheumatism (EULAR) and the American college of rheumatology (ACR) classification criteria for systemic lupus erythematosus [7]. Thus, rheumatologic consult was ordered.
Table 1 . Laboratory findings.