(Figure 4)
Based on his clinical and imaging findings, he was diagnosed with recurrent pericarditis complicated by constrictive physiology. Given his frequent recurrences, he was treated with ibuprofen 800 mg three times a day, colchicine 0.6 mg twice a day and prednisone 40 mg daily. He was counseled on the need for strict exercise restriction and adherence to medication. Additionally, the criteria for advancing the therapy to biologics (anakinra) or pericardiectomy was also discussed. Unfortunately, 4 months after his visit, he developed another recurrence. Given his significant limitation in quality of life (QoL), he elected to undergo pericardiectomy. Surgical pathology revealed organized pericarditis without any evidence of necrosis or necrobiosis.
At 6-month follow-up, he reported significant improvement in his functional capacity, and QoL He reported no further flares. ESR, CRP, and hs-CRP were normal. ECG demonstrated normal sinus rhythm. Repeat transthoracic echocardiogram revealed no constrictive physiology but displayed development of new mild tricuspid regurgitation. His colchicine was tapered from 0.6 mg to 0.3 mg daily and was instructed to follow up in 6 months for further tapering.