Unmasking the Great Masquerader: Autoimmune Pericarditis
A 28-year-old woman with a past medical history of systemic lupus erythematosus (SLE) presented with 1.5 years of shortness of breath and left-sided pleuritic chest pain. Her previous manifestations of SLE included joint inflammation, pleuritis, and shrinking lung syndrome. During a hospital admission for shortness of breath one year prior, she was found to have reaccumulation of bilateral pleural effusions despite prior drainage. As a result, she underwent left-sided video-assisted thoracoscopic surgery and pleural biopsy, which showed chronic pleuritis. During that admission, she was also found to have a trace pericardial effusion with no tamponade physiology. After discharge, her symptoms of shortness of breath and left-sided pleuritic chest pain persisted, and she was unable to exercise or work. The following year, she was referred to a cardiologist for reassessment of her previously-seen trace pericardial effusion.
Her medications included mycophenolate mofetil 1,000 mg PO BID, hydroxychloroquine 400 mg PO daily, amlodipine 5 mg PO daily, cholecalciferol 50,000 units q weekly, and recently completed prednisone taper of 1.5 years' duration for treatment of her pleuritis/serositis and joint inflammation.
On physical examination, blood pressure was 137/90, heart rate 63 beats per minute, oxygen saturation was 100% on room air, and body temperature was 36.5 degrees Celsius. There was no pulsus paradoxus present. There was no rub or knock present on cardiac auscultation. There was no ascites or peripheral edema. Laboratory investigations showed C-reactive protein 0.2 (< 0.9 mg/dL), ultrasensitive C-reactive protein 2.0 (< 3.1 mg/L), erythrocyte sedimentation rate 10 (0-20 mm/hr). Electrocardiogram was obtained.
Repeat echocardiogram revealed preserved left ejection fraction but did not demonstrate a pericardial effusion. Cardiac magnetic resonance imaging (CMR) study was performed and revealed acute and subacute pericardial inflammation.
What is the management of this patient's presentation of acute pericarditis?