Article Type : Case Report
Authors : Degirmenci H, Bakirci EM, Caliskan M, Gunduz T and Tan D
Keywords : Ankylosing spondylitis; Pericardial effusion and rare
Ankylosing spondylitis is a chronic systemic inflammatory
rheumatic disease involving the sacroiliac joints. Uveitis is a systemic
disease that can involve lungs, kidneys and heart. While extracardiac
involvement is common, cardiac involvement is rare. Ankylosing spondylitis is
seen in approximately 1-2 of every 1000 people. It is seen 3-4 times more in
men than in women [1,2]. While involvement of the aortic valve, ascending aorta
and conduction system is common in ankylosing spondylitis, pericardial
involvement is rare. In this case, we present a rare case with pericardial
effusion due to Ankylosing Spondylitis.
Between the pericardium leaves
surrounding the heart, there is less than 50 ml of serous, physiological fluid
that can vary dynamically [1].
This amount of fluid is useful in performing the functions of the heart.
However, the increase in the amount of fluid is called pericardial effusion and
it impairs diastolic functions of the heart by increasing intrapericardial
pressure. Ankylosing spondylitis is a chronic systemic inflammatory rheumatic
disease that is common in young men and primarily involves the axial joints [2]. Extraarticular manifestations are common and severe. While
uveitis, intestinal diseases, lung involvement, and kidney involvement are
common, cardiac involvement is rare. The main pathophysiological mechanism
responsible for this involvement is the sclerosing inflammatory process [3]. Aortic valve involvement, ascending aortic involvement and
conduction system involvement are common in cardiac involvement due to this
mechanism. However, pericardial involvement is less common [4]. In this article, we presented a rare case of pericardial
effusion due to Ankylosing Spondylitis.
A 51-year-old male patient was admitted to our clinic with pleuritic pain in the left hemithorax that started 10 days ago, palpitations and shortness of breath. It was learned from her history that she had been diagnosed with Ankylosing Spondylitis for 3 years. The patient's blood pressure arteriole was 80 / 50mmHg, heart rate 130 / min, and respiratory rate 22 / min. Laboratory tests were unremarkable. There was sinus tachycardia on electrocardiography (Figure 1).
Figure 1: Electrocardiography shows sinus tachycardia.
There was no feature other than cardiomegaly on chest radiography (Figure 2). In echocardiography, there was a global 20 mm pericardial effusion in the diastole around the heart. The patient was started on colchicine 0.5 mg 2x1 and nonsteroidal anti-inflammatory. Pericardiocentesis was planned for the patient because of the hemodynamics of the patient. Seldinger, 6 F sheat, 0.035 guidewire, pigtail catheter and 50 ml injector were used for this procedure. Pericardiocentesis was applied to the patient. Pericardial fluid was hemorrhagic (Figure 3).
Figure 2: Cardiomegaly is seen on chest radiography.
Figure 3: Hemorhagic view of pericardiocentesis specimen.
After pericardiocentesis
was performed to the patient, a sample of periceal fluid was sent for
diagnostic purposes. Pericardial fluid was evaluated as exudate according to
the results of samples sent from pericardiocentesis fluid. No malignant cell
was detected in the pathology evaluation. Tuberculosis was not detected. The
present pericardial effusion was evaluated to be caused by Ankylosing
Spondylitis. The patient was followed up in our clinic for 10 days. When the
pericardial fluid withdrawn from the daily sheat fell below 50 ml, the sheat
was withdrawn. The patient's clinical condition improved.
Ankylosing spondylitis is
a chronic systemic inflammatory rheumatic disease involving the sacroiliac
joints. Uveitis is a systemic disease that can involve lungs, kidneys and
heart. While extracardiac involvement is common, cardiac involvement is rare.
Ankylosing spondylitis is seen in approximately 1-2 of every 1000 people. It is
seen 3-4 times more in men than in women [1,2]. While involvement of the aortic
valve, ascending aorta and conduction system is common in ankylosing
spondylitis, pericardial involvement is rare. In our case, there was no valve
involvement due to ankylosing spondylitis, ascending aorta and conduction
system involvement [3,4]. However, there was pericardial involvement, which is
a rare involvement. In the literature, the echocardiographic features of
Ankylosing Spondylitis include thickening of the posterior aortic wall, aortic
insufficiency, small pericardial effusions, thickening of the aortic and mitral
valve without regurgitation [5,6]. In our case, pericardial effusion is large
and it differs from the literature in this respect. As a result, although
Ankylosing Spondylitis mostly causes aortic valve involvement, ascending aortic
involvement or conduction disturbances, pericardial effusion should also be
considered.