University of Wisconsin–Madison Medical College of Wisconsin

A Triad of Pericarditis, Pericardial Effusion, and Pleural Effusion as the Predominant Presentation of Rheumatoid Arthritis — A Case Report

Adam Devine, MD; Michael Aljadah, MD; Rebecca Weiner, DO; Iryna Nemesh, MD; Divyanshu Mohananey, MD

WMJ. 2022;121(4):e75-e78

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We describe a case of a 67-year-old African American man who presented to the emergency department with a sharp, pleuritic chest pain and shortness of breath. After several admissions and extensive workup, he ultimately was diagnosed with a persistent pleural effusion, pericardial effusion, and secondary constrictive pericarditis due to rheumatoid arthritis. By highlighting immunological disorders such as rheumatoid arthritis in the differential diagnosis, in the setting of a refractory pericardial effusion and serositis, this case report addresses key aspects of the presentation both in the emergency and inpatient settings, reviews the criteria for a rheumatoid arthritis diagnosis, and emphasizes areas of importance in predominantly cardiopulmonary extra-articular manifestations of a typically musculoskeletal disease.

Author Affiliations: Department of Internal Medicine, Medical College of Wisconsin Affiliated Hospitals (MCWAH), Milwaukee, Wisconsin (Devine, Aljadah); Department of Rheumatology, MCWAH, Milwaukee, Wis (Weiner, Nemesh); Department of Cardiology, MCWAH, Milwaukee, Wis (Mohananey).
Corresponding Author: Adam Devine, MD, 8701 Watertown Plank Rd, Milwaukee, WI 53226; phone 708.752.1071; email; ORCID ID 0000-0002-0404-8306
Acknowledgements: The authors wish to thank Ivor J. Benjamin, MD, professor and director of the Cardiovascular Center at the Medical College of Wisconsin, for his critical reading and encouragement during preparation of this manuscript.
Ethics Approval: Our institution does not require ethical approval for case reports.
Informed Consent: Verbal informed consent was obtained from the patient(s) for their anonymized information.
Funding/Support: None declared.
Financial Disclosures: None declared.