(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.