Abstract 12735: Autoimmune Recurrent Pericarditis in Pregnancy: A Multidisciplinary Approach

Abstract

Background: Recurrent pericarditis in pregnancy is uncommon and the data regarding the safety and efficacy of conventional therapy is sparse. We describe a multidisciplinary approach to managing a challenging case of chronic, recurrent pericarditis in the setting of newly-diagnosed systemic lupus erythematosus (SLE) and pregnancy. Case: 28-year-old female at 24 weeks gestation with no known medical history presents with sharp, pleuritic and positional chest pain and hypotension. Transthoracic echocardiography reveals acute, effusive pericarditis with features of tamponade. Despite emergent pericardiocentesis, pericardial window placement and treatment with steroids, she had recurrence of pericarditis the following month. Due to the recurrent nature of pericarditis of unknown etiology and pregnancy, clinicians were faced with a diagnostic and therapeutic dilemma. Decision Making: After extensive testing to rule out malignancy, bacterial and fungal infections, she was diagnosed with SLE - the culprit of her recurrent pericarditis. An multidisciplinary approach among cardiology, rheumatology and obstetrics was taken to determine an optimal therapeutic regimen and several risk-benefit discussions were conducted with the patient and family. In order to treat both recurrent pericarditis and SLE, she was tapered off of steroids initiated on Azathioprine 50 mg and low-dose Colchicine 0.3 mg twice daily. She was followed closely with cardiac MRI (Figure 1) and ultimately delivered a healthy child despite her new diagnoses. Conclusion: This case showcases the complexity of managing recurrent pericarditis in the setting of pregnancy and comorbid conditions and supports the use of Colchicine and Azathioprine for this population despite the lacking literature. This case also emphases the importance of multidisciplinary teamwork, clinical acumen and the value of patient-centered care when determining a course of therapy for a challenging patient.