A large chronic pericardial effusion in an ultramarathon runner with anti-CCP positive rheumatoid arthritis

BMJ Case Rep. 2017 Jun 13:2017:bcr2017219350. doi: 10.1136/bcr-2017-219350.

Abstract

Pericardial effusions arise as an extra-articular manifestation of rheumatoid arthritis (RA). Pericardial effusions are often asymptomatic, particularly in the early phase, but patients are at risk of cardiac tamponade as the effusion progresses. We discuss the case of a 40-year-old male ultramarathon runner with RA who presented with mild pleuritic chest pain and exertional dyspnoea after a recent long-haul flight. Despite a relative tachycardia, his observations were otherwise unremarkable. His blood tests revealed a C-reactive protein (CRP) of 86 mg/L and an anti-cyclic citrullinated peptide (anti-CCP) titre of 360 units/mL. He was initially diagnosed with a pulmonary embolism; however, a large pericardial effusion was found incidentally on CT pulmonary angiogram with over 1500 mL subsequently drained. The patient's symptoms resolved and CRP normalised 2 weeks later. This unique case illustrates that physically fit patients may physiologically compensate for large pericardial effusions and that arthritic symptoms do not correlate with the severity of extra-articular features in RA.

Keywords: cardiovascular medicine; emergency medicine; rheumatoid arthritis; sports and exercise medicine.

Publication types

  • Case Reports

MeSH terms

  • Arthritis, Rheumatoid*
  • Autoantibodies / blood
  • C-Reactive Protein / metabolism
  • Chest Pain / etiology
  • Diagnosis, Differential
  • Female
  • Humans
  • Middle Aged
  • Peptides, Cyclic / immunology
  • Pericardial Effusion / complications
  • Pericardial Effusion / diagnosis*
  • Pericardial Effusion / diagnostic imaging
  • Pericardial Effusion / immunology
  • Pericarditis / complications
  • Pericarditis / diagnosis*
  • Pericarditis / diagnostic imaging
  • Pericarditis / immunology
  • Running*
  • Sports*
  • Tomography, X-Ray Computed

Substances

  • Autoantibodies
  • Peptides, Cyclic
  • cyclic citrullinated peptide
  • C-Reactive Protein

Supplementary concepts

  • Pericardial Effusion, Chronic