Management of Resistant Pericarditis in an End Stage Renal Disease Patient - Case Presentation

A 75 year old female receiving dialysis 3 times weekly due to end-stage renal disease (ESRD), secondary to polycystic kidney disease, presented to the emergency room. She complained of right upper quadrant pain together with pleuritic chest pain. The chest pain worsened on deep inspiration and on lying down flat, but improved on sitting up and bending forwards. An abdominal ultrasound, performed due to a known liver cyst, revealed a solid dense lesion, which was not indicative of a cyst. There was the suspicion that the lesion may have been infectious or hemorrhagic in nature. As a result the patient was admitted to the surgical department for further evaluation. Due to her failure to respond to antibiotic treatment a PET-CT with F-18-FDG was ordered. The studies revealed increased mediastinal absorption between her large vessels and pericardium as well as a small pericardial effusion. Her serum CRP peak was 236.83 mg/l, the troponin was negative and her blood urea was 42 mg/dl (15-45 mg/dl). The ECG did not show any typical changes of pericarditis.