Pericarditis With Cardiac Tamponade Mimicking Yellow Nail Syndrome in a Patient With Rheumatoid Arthritis and a Paucity of Joint Symptoms

Abstract

Pericarditis is a cardiac disease that commonly manifests with rheumatoid arthritis, and its complications are related to rheumatoid arthritis disease activity. The diagnosis can be complicated in patients with multiple extra-joint complications of rheumatoid arthritis. We report a case of pericarditis in an 82-year-old woman with few joint symptoms who was admitted to the hospital due to worsening edema of the lower legs and dyspnea, which progressed to cardiac tamponade. The patient presented with gradual onset of edema of both lower limbs and bilateral pleural effusion and was initially diagnosed with yellow nail syndrome. Ultimately, the patient was diagnosed with rheumatoid pericarditis due to a rapid increase in pericardial effusion. She was treated with non-steroidal anti-inflammatory drugs (NSAIDs) and colchicine; however, the symptoms were progressive and required pericardiocentesis. After pericardiocentesis, the patient responded well to NSAIDs and colchicine, and systemic edema was relieved. This case highlights the fact that pericarditis associated with rheumatoid arthritis is not necessarily related to the severity of joint symptoms. Moreover, it can be difficult to differentiate pericarditis from multiple other diseases, such as yellow nail syndrome, in patients with rheumatoid arthritis who mainly have extra-articular symptoms.

Autoimmune Vasculitis Causing Acute Bilateral Lower Limb Paralysis

“…In many cases, voluntary care often alerts patients and preserves their quality of life [15,16]. However, some patients do not promptly seek medical care and visit hospitals with gradually increasing and progressive pathologies, as in the present case [17,18]. To ensure the provision of effective community medical care services in the future, it is necessary to promote appropriate and prompt visits to healthcare facilities.…”

Hemodialysis-Related Pericarditis With Cardiac Tamponade

“…Furthermore, given the immunosuppressed state of patients on dialysis, it is critical to consider various pathological conditions as the cause of pericarditis. In the present case, the differential diagnosis included idiopathic, viral, uremic, autoimmune, and neoplastic conditions [ 10 , 11 ]. The pericardial fluid included neutrophils/lymphocytes and no evidence of bacteria.…”

Secondary Failure of Tocilizumab in Treating Elderly-Onset Rheumatoid Arthritis With Systemic Symptoms Complicated by Diverticulum Perforation

“…As a result, medical professionals deal with their symptoms in a mild and undeferential manner, with symptomatic treatment affected by ageism [ 16 , 17 ]. In particular, various symptoms often appear because of autoimmunity in older patients with autoimmune diseases such as RA [ 18 , 19 ]. Therefore, we strongly suggest considering various possibilities of RA when symptoms of older patients with RA worsen; to this end, health care professionals should take accurate clinical histories, perform precise physical examinations, and follow up with the patients closely.…”