Talc-induced pericardial granulomatosis after recurrent pleurodesis: a rare cause of incessant pericarditis—case report

Abstract

Background Management of relapsing pericarditis in patients who do not respond to medical therapy presents a significant challenge for clinicians. Although pericardiectomy remains a controversial option, it can provide effective relief of symptoms in this group of patients, as we report in this rare case of incessant pericarditis. Case Summary We report the case of a 41-year-old woman with a medical history of two episodes of acute pericarditis, with no symptom-free intervals between them, over a two-year period. These episodes appeared following a third talc pleurodesis that was performed for relapsing catamenial pneumothorax. She became unresponsive to medical treatment with colchicine, indomethacin, anakinra and prednisone, and surgery was finally indicated for symptom relief. An anterior pericardiectomy was performed in which talc-induced pericardial foreign body granulomas where identified in the pericardium and mediastinum samples. Patient recovered painless after six months and no pericardial effusion was shown during the follow-up. Discussion Although talc is a safe sclerosing agent for pleurodesis for the treatment of recurrent spontaneous pneumothorax, extrapleural dissemination to mediastinum and pericardium is plausible, as documented in experimental animal studies. However, to date we could not find any case of talc-induced pericarditis as an extrapulmonary complication of pleurodesis in the medical literature. In this instance, pericardiectomy was a mandatory alternative for symptomatic relief of foreign-body-induced pericarditis and yielded a good clinical outcome.