RESUMO

BACKGROUND Pericarditis is common in rheumatoid arthritis, mostly occurring as an extra-articular manifestation of the disease. We describe a patient with stable rheumatoid arthritis who presented with a large pericardial effusion and a compressive fibrotic pericardial mass. The patient had recently started treatment with a tumor necrosis factor-alpha (TNF-alpha) antagonist. CASE REPORT The patient was a 58-year-old woman with rheumatoid arthritis who presented with right ventricular compression caused by a pericardial fibrotic mass and a large pericardial effusion. The patient did not have active arthritis at the time of presentation. She had been started on treatment with a tumor necrosis factor-alpha (TNF-alpha) antagonist 4 months prior to this presentation. She was successfully treated with surgical pericardiectomy and resection of the pericardial mass. Pathologic analysis of the pericardial mass demonstrated fibrosis and no evidence of active inflammation, rheumatoid arthritis, opportunistic infection, or malignancy. CONCLUSIONS We describe a patient with stable rheumatoid arthritis who developed subacute right heart compression syndrome secondary to pericardial effusion and fibrous pericardial mass. The exact cause of pericarditis and the pericardial mass remain uncertain. There is a need for increased awareness of the association between use of TNF-alpha antagonists and the possible development of an intrapericardial fibrotic mass and effusion.

Assuntos

Artrite Reumatoide/tratamento farmacológico , Tamponamento Cardíaco/etiologia , Derrame Pericárdico/diagnóstico por imagem , Pericardite/patologia , Pericárdio/patologia , Anticorpos Monoclonais/uso terapêutico , Antirreumáticos/uso terapêutico , Tamponamento Cardíaco/diagnóstico por imagem , Tamponamento Cardíaco/cirurgia , Ecocardiografia , Feminino , Fibrose , Humanos , Imagem Cinética por Ressonância Magnética , Pessoa de Meia-Idade , Derrame Pericárdico/cirurgia , Pericardiectomia , Pericardite/cirurgia , Pericárdio/cirurgia , Fator de Necrose Tumoral alfa/antagonistas & inibidores

RESUMO

Success and advances in the management of all aspects of heart disease and heart transplantation have allowed for normalcy in life, including the question as to the possibility of pregnancy in transplantation. With the growing young adult population undergoing heart transplant, pregnancy and transplantation have become an issue of importance. Despite the fact that nearly 50 years have passed since the first heart transplant, there remains to be little evidence in regard to management of pregnant heart transplant recipients. Thus, this review will address issues related to pregnancy in this patient population, such as preconception counseling, timing and optimization for pregnancy post transplant, immunosuppression, cardiac assessment, and management of pregnant heart transplant recipients, as well as hemodynamic effects of pregnancy on the transplanted heart. Based on the available literature from registrar data, case reports and series, with careful planning, monitoring, and appropriate therapies, pregnancy in heart transplantation is a viable option in select patients. To optimize maternal and fetal outcomes, recommendations are included in this review to minimize complications including rejection, graft dysfunction, maternal diabetes and hypertension, as well as appropriate changes in immunosuppression.