A rare cause of pericardial effusion: giant cell arteritis

Simultaneous Pleural and Pericardial Effusion as First Clinical Manifestations of Giant Cell Arteritis: A Case Report

Giant cell arteritis (GCA) is a chronic granulomatous vasculitis of unknown aetiology occurring in the older patients and affecting mostly the cranial branches of the arteries originating from the aortic arch. GCA is associated with polymyalgia rheumatica (PMR). Clinical features of the disorder include headache, scalp tenderness, jaw claudication, temporal artery abnormalities on physical examination, vision changes, and symptoms associated to PMR. Systemic manifestations include fever, anorexia and weight loss while less rare manifestations are related to the nervous system, the respiratory system, the pericardium and extra-cranial large vessels. Here we report a rare case of simultaneous pleural and pericardial effusion as the first manifestations of GCA. The diagnosis was made with a temporal artery biopsy. Such a diagnosis should, therefore, be considered in older patients presenting with pleuropericardial manifestations, even in the absence of typical clinical features.

Pericarditis among giant cell arteritis patients: From myth to reality

BACKGROUND

Giant cell arteritis (GCA) is an inflammatory disease of unknown etiology affecting adults age > 50 years. GCA (also known as temporal arteritis) is a vasculitis of large and medium-size vessels that involves the extracranial branches of the carotid artery. Common manifestations include constitutional symptoms, headache, jaw claudication, scalp tenderness, and vision loss. Cardiac involvement in GCA is considered to be as low as 5%, and < 30 cases of pericarditis among GCA patients have been reported in the literature. The aim of this study was to evaluate the association between GCA and pericarditis by conducting a cross-sectional study utilizing the database of the largest healthcare provider in Israel.

HYPOTHESIS

GCA is associated with pericarditis.

METHODS

The proportion of past documentation of pericarditis among patients diagnosed with GCA was compared with that of their age- and sex-matched controls. Univariate analysis was performed using the χ² and t tests; multivariate analysis was performed using logistic regression.

RESULTS

The study included 4329 GCA patients and 21 611 controls. GCA patients had higher rates of cardiovascular risk factors. Pericarditis was observed in 53 GCA patients and 72 controls (1.22% vs 0.33%, respectively; P < 0.001), significantly higher among GCA patients in comparison with controls. A significant interaction was found between GCA, pericarditis, and young age (<70 years).

CONCLUSIONS

The study showed an independent association between GCA and pericarditis, especially among young patients. Proper screening should be applied whenever a suspicion arises as to the existence of comorbidity in patients with either disease.