Abstract 16555: Neutrophil to Lymphocyte Ratio: A Marker of Inflammation in Pericardial Disease

Abstract

Introduction: Neutrophil-to-lymphocyte ratio (NLR) reflects the intricate relationship between the innate and adaptive immune systems during inflammatory states. With NLR known to be a sensitive indicator of inflammation, its role as a marker in acute pericarditis is yet to be investigated. Here we describe a rare case of acute pericarditis with an elevated NLR highlighting the potential impact this marker can have within the diagnostic evaluation of pericardial disease. Clinical Case: 46-year-old male with a past medical history of long QT syndrome, crohn's disease, ankylosing spondylitis, psoriatic arthritis, and histoplasmosis who presented with a four-day history of pleuritic chest pain, fever, and chills. The patient had a recent admission two months prior for pericardial effusion s/p emergent pericardial window. Cultures then showed acute and chronic inflammatory granulation tissue and necrosis with no evidence of malignancy and negative stains for fungal organisms. He was discharged home with ibuprofen without improvement. Upon arrival, the patient was hemodynamically stable with a workup notable for leukocytosis of 13.82x 10 9 /l, elevated CRP of 22.5 mg/dL and ESR of 65 mm/hr. NLR was 7.0. Echocardiography showed preserved ejection fraction with moderate circumferential pericardial effusion (figure A). The patient was started on colchicine in addition to ibuprofen. The cardiac MRI obtained showed evidence of moderate active pericarditis (figure B, C). A decision was ultimately made to start inpatient anakinra with a plan to discharge on triple therapy with colchicine, ibuprofen, and rilonacept. Discussion: NLR has the potential to be a novel inflammatory marker in pericardial disease associated with pericardial inflammation and edema. A normal range of NLR is between 1-2, with values higher than 3.0 and below 0.7 considered pathological. Our case highlights the importance of NLR as a diagnostic and prognostic marker of pericardial disease.