English

S Mujtaba,Sl Kamholz

doi:10.13172/2052-0077-2-3-467

Abstract

Abstract Introduction There are multiple causes of pericardial effusion, including drugs. Avonex® (interferon beta-1a) is an immunomodulator used for the treatment of multiple sclerosis. Adverse cardiac effects associated with the use of Avonex® are exceedingly rare. To date, only one case has been reported by the United States Food and Drug Administration, associating the use of Avonex® with the development of pericardial effusion. We report the second such case. Case report A 44-year-old woman with a history of multiple sclerosis, asthma and schizophrenia presented to the Emergency Department with increasing shortness of breath for 2 months, which had acutely worsened that morning, orthopnoea and an unintentional weight loss of 10 pounds over the last 6 months. On examination, the patient was found to be short of breath but haemodynamically stable. Notable findings included bilateral wheezing, jugular venous distension and pulsus paradoxus. An electrocardiogram showed a normal sinus rhythm without electrical alternans. Chest radiograph revealed cardiomegaly; a transthoracic echocardiogram showed a large pericardial effusion with evidence of increased pericardial pressure and impending cardiac tamponade. Additional history revealed that the patient had been started on Avonex® 30 mcg once weekly several months prior. A comprehensive work to exclude all potential causes of pericardial effusion, including connective tissue disorders and infectious aetiologies, proved unrevealing. Surgical drainage was performed. A cytological examination of the pericardial fluid revealed benign mesothelial cells; tissue examination confirmed focal mesothelial hyperplasia. A tuberculin skin test was negative. Computed tomographic scanning of the chest, abdomen and pelvis did not show any evidence of an occult malignancy. Conclusion The patient and her neurologist were alerted to the possibility of Avonex®induced pericardial effusion due to the lack of evidence for other aetiologies. Despite the relative dearth of data on Avonex®-related pericardial effusion, this diagnosis is one that merits consideration to prevent potential morbidity and mortality.

Highlights

There are multiple causes of pericardial effusion, including drugs
Computed tomographic scanning of the chest, abdomen and pelvis did not show any evidence of an occult malignancy. The patient and her neurologist were alerted to the possibility of Avonex®induced pericardial effusion due to the lack of evidence for other aetiologies
Avonex® is an immunomodulator approved by the United States Food and Drug Administration (FDA) in 2003 for the treatment of multiple sclerosis (MS)

Summary

Conclusion

Our patient underwent an exhaustive work-up to determine the aetiology of the pericardial effusion. The process of elimination ruled out all other potential causes. The most plausible cause of pericardial effusion in this case appeared to be an adverse reaction related to the use of Avonex®. Despite the relative paucity of data on Avonex®-related pericardial effusion, this diagnosis, albeit of one exclusion, is one that must be promptly recognized in order to avoid potential morbidity and mortality. Consent Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Abbreviations list CT, computed tomographic; FDA, Food and Drug Administration; MS, multiple sclerosis; OR, operating room

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