Cholesterol pericarditis associated with rheumatoid arthritis: A rare cause of pericardial effusion

Abstract

Cholesterol pericarditis is an uncommon form of pericardial disease, of unknown pathophysiology, that is characterized by chronic relapsing, usually large, pericardial effusions that are distinctive due to high levels of cholesterol in the pericardial fluid, with or without the formation of crystals [ 1 Alexander S.J. A pericardial effusion of “gold paint” appearance due to presence of cholesterin. Br Med J. 1919; 2: 463 Crossref PubMed Scopus (27) Google Scholar , 2 Brawley R.K. Vasko J.S. Monrow A.G. Cholesterol pericarditis: consideration of its pathogenesis and treatment. Am J Cardiol. 1966; 41: 235-248 Scopus (33) Google Scholar ]. It is usually idiopathic, but can be associated with various systemic diseases such as hypothyroidism, rheumatoid arthritis and tuberculosis. In the case of rheumatoid arthritis (RA), release of cholesterol from pericardial cell membranes or from necrotic rheumatoid nodules, lysis of red blood cells, lymphatic obstruction and reduced pericardial absorption capacity have all been suggested as possible mechanisms [ 3 Knobel B. Rosman P. Cholesterol pericarditis associated with rheumatoid arthritis. Harefuah. 2001 Jan; 140 (87): 10-12 PubMed Google Scholar , 4 Fernandes F. Vieira G.S. Arteaga E. Ianni B.M. Pego-Fernandes P. Mady C. Cholesterol pericarditis. A specific but rare cause of pericardial disease. Arq Bras Cardiol. May 2001; 76: 391-394 Crossref PubMed Scopus (15) Google Scholar , 5 Stanley R.J. Subramanian R. Lie J.T. Cholesterol pericarditis terminating as constrictive calcific pericarditis. Am J Cardiol. 1980; 46: 511-514 Abstract Full Text PDF PubMed Scopus (14) Google Scholar , 6 Ford E.J. Bear P.A. Adams R.W. Cholesterol pericarditis causing cardiac tamponade. Am Heart J. 1991; 122: 877-879 Abstract Full Text PDF PubMed Scopus (8) Google Scholar ]. Although its clinical course is usually indolent and complications such as cardiac tamponade and chronic constrictive pericarditis are relatively rare, the need for surgery for complete treatment has been reported in at least 10% of cases [ [7] Raposo Luís et al. Cholesterol pericarditis — relapsing pericardial effusion in a patient with rheumatoid arthritis. Rev Port Cardiol. 2005; 24: 737-745 PubMed Google Scholar ].