Iranian Heart Journal

Iranian Heart Journal

Massive Inflammatory Pericardial Effusion in Spondyloarthritis: Noninvasive Management Success

Document Type : Case Report

Authors
Mochammad Yusuf Alsagaff 1 ΒΆ
Ken Christian Kawilarang 1
Hendri Susilo 1
Nadya Luthfah 1
Cahyo Wibisono Nugroho 2
1 Department of Cardiology and Vascular Medicine, Dr Soetomo General Academic Hospital, Surabaya, East Java, Indonesia.
2 Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia.
Abstract
Spondyloarthritis is a chronic systemic inflammatory disease that primarily affects the spine, sacroiliac joints, and tendons. Cardiac involvement is uncommon but may manifest as pericardial effusion, posing diagnostic and therapeutic challenges. This case underscores the significance of recognizing systemic inflammatory diseases as potential causes of pericardial effusion and the role of conservative management in avoiding unnecessary invasive interventions.
A 24-year-old man presented with acute dyspnea, orthopnea, and pleuritic chest pain. Clinical evaluation and imaging revealed a massive pericardial effusion without echocardiographic signs of cardiac tamponade. Laboratory workup demonstrated elevated inflammatory markers, leading to a differential diagnosis that included systemic inflammatory diseases. The patient was initially managed with nonsteroidal anti-inflammatory drugs (NSAIDs) and colchicine. Nonetheless, persistent pericardial effusion prompted further evaluation, ultimately leading to a diagnosis of spondyloarthritis based on radiographic evidence of sacroiliitis and positive rheumatoid factor. A regimen of corticosteroids and sulfasalazine resulted in complete resolution of pericardial effusion and normalization of inflammatory markers.
Inflammatory pericardial effusion can be the initial manifestation of spondyloarthritis, and targeted medical therapy may obviate the need for invasive intervention. Clinicians should consider systemic inflammatory diseases in unexplained pericardial effusion and prioritize individualized treatment approaches. (Iranian 93Heart Journal 2026; 27(1): 93-100)
Keywords
100pericardial effusion
spondyloarthritis
pericardiocentesis
systemic inflammatory disease
conservative management
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Iranian Heart Journal
Volume 27, Issue 1
Winter 2026
Pages 93-100