AI Article Synopsis
- IgG4-related effusive constrictive pericarditis (ECP) is a rare but serious condition that can cause heart issues like cardiac tamponade and heart failure, primarily treatable with glucocorticoids to reduce inflammation and fibrosis.
- A recent case of a 66-year-old woman demonstrated the effectiveness of fluorine-18 fluorodeoxyglucose (F-FDG) PET/CT scanning in diagnosing and monitoring treatment response for this condition, showing increased F-FDG uptake in the pericardium.
- After treatment with prednisolone and colchicine, the patient exhibited significant improvement in symptoms and imaging, allowing for successful tapering of medications.
Article Abstract
Background: Immunoglobulin G4 (IgG4)-related effusive constrictive pericarditis (ECP) is a rare manifestation of IgG4-related disease (IgG4-RD). It can lead to persistent pericardial fibrosis, resulting in cardiac tamponade, diastolic dysfunction, and heart failure. Glucocorticoids are the primary treatment for effectively reducing inflammation and preventing fibrosis. However, guidelines for monitoring treatment response are lacking and tapering glucocorticoid therapy for specific target organs remains a challenge. Recent studies on IgG4-RD have demonstrated that semiquantitative measurements of fluorine-18 fluorodeoxyglucose (F-FDG) uptake in the main involved organs in positron emission tomography/computed tomography (PET/CT) scanning are correlated to disease activity. We present a case of IgG4-related ECP to demonstrate the usefulness of F-FDG PET/CT for diagnosing and treatment follow-up of IgG4-related ECP.
Case Presentation: Herein, a 66-year-old woman diagnosed with IgG4-related ECP presented with breathlessness, leg swelling, rales, and fever. Laboratory tests revealed markedly elevated levels of C-reactive protein, and transthoracic echocardiography revealed constrictive physiology with effusion. High IgG4 levels suggested an immune-related pathogenesis, while viral and malignant causes were excluded. Subsequent pericardial biopsy revealed lymphocyte and plasma cell infiltration in the pericardium, confirming the diagnosis of IgG4-related ECP. F-FDG PET/CT revealed increased uptake of F-FDG in the pericardium, indicating isolated cardiac involvement of IgG4-RD. Treatment with prednisolone and colchicine led to a rapid improvement in the patient's condition within a few weeks. Follow-up imaging with F-FDG PET/CT after 3 months revealed reduced inflammation and improved constrictive physiology on echocardiography, leading to successful tapering of the prednisolone dose and discontinuation of colchicine.
Conclusion: The rarity of IgG4-related ECP and possibility of multiorgan involvement in IgG4-RD necessitates a comprehensive diagnostic approach and personalized management. This case report highlights the usefulness of F-FDG PET/CT in the diagnosis and treatment follow-up of isolated pericardial involvement in IgG4-RD.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10885613 | PMC |
| http://dx.doi.org/10.1186/s12872-024-03797-z | DOI Listing |
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