ACUTE PERICARDITIS in TIMES of COVID

ABSTRACT

Background: The most common etiology of acute pericarditis is usually infectious, especially viral. When its cause is infammatory (up to 7% of cases), it can be presented as an isolated process or be a clinical manifestation in the context of multiple systemic autoimmune diseases (SAD), therefore it is necessary to make a broad differential diagnosis. Nowadays, an increased incidence has been described in relation to SARS-CoV-2 infection, and especially in global vaccination against this one. This represents a clinical challenge when we have to identify the cause of this pathology with a not insignifcant comorbidity. Objectives: To describe the characteristics of a series of patients with acute pericarditis and its association with SAD. Methods: Retrospective and descriptive observational study. Digitalised records of patients with acute pericarditis evaluated in the Rheumatology unit of a tertiary hospital in Seville during 2021 were reviewed. Demographic, epidemiological, clinical and therapeutic variables were analysed. Results: Eight cases of acute pericarditis were detected. The average age of the patients was 51.50 ± 18.601 years. 62.5% were women. 50% had previous rheumatological pathology two rheumatoid arthritis (RA), one systemic lupus erythematosus (SLE) and one limited systemic sclerosis (LSS);with an average disease duration of 8.63 ± 2.387 months. Of these, 3 were on treatment with steroids and DMARDs (lefunomide or hydroxychloroquine) and 1 had previously received rituximab. Pericardial effusion was moderate in 50% of cases, severe in 33.3% and mild in 16.7%. One patient had cardiac tamponade. Five patients had pleural effusion, which was moderate in 80%, and in one case associated with pneumonia. As complications, one patient developed heart failure and the patient with ESL was diagnosed with pulmonary arterial hypertension. Two patients had previous COVID19 and 7 were vaccinated against Sars-CoV2. Treatment was colchicine in 57.15% of cases, steroids in 85.7%, DMARDsc in 85.8% (3 hydroxychloroquine and 3 azathioprine) and DMARDsb in 42.9% (1 anakinra, 1 tocilizumab and 1 rituximab). Pericarditis resolved in all patients. Table 1. Conclusion: In the previous year, an increase in consultations from other departments for acute pericarditis with suspected infammatory origin was observed. The possibility of a correlation with COVID19 or vaccination against COVID was initially considered, but it could not be demonstrated, since vaccination was later in vaccinated patients, and in those who had been infected, the time interval until the development of pericarditis was too long for it in order to be attributed to COVID19. Finally, in 5 of the 8 patients, pericarditis was related to SAD, in particular with the rheumatic pathologies most associated with this clinical manifestation (RA and SLE). Therefore, in the middle of the COVID pandemic, in addition to considering COVID19 or its vaccine in the differential diagnosis of acute pericarditis, we must not forget to include SAD in this diagnosis.