Dressler Syndrome

Posted By Gabriele Missale on December 26, 1998 at 17:24:11:







I am an italian physician. My father is the patient. He is 75 years old, he is diabetic, and he is affected with Chronic lymphatic leukemia (B-cell) and coronary heart disease. For this last condition he underwent 40 days ago a CABG (one mammary artery and two anastomosis with the saphena vein), one week after the surgery he developed a right pleural effusion which was treated with low dose of steroids, because of no response and the increase in the amount of the effusion, about on day 15 from the surgery he underwent the first thoracentesis (600 ml of sero-hemorragic fluid). The effusion  reappeared after a short time on both sides of the chest and a pericarditis showed up also, a second thoracentesis was performed (the fluid was analyzed: showing and high cell number -3000/mm3- mainly T-cells, colture were negative for bacteria, and TBC colture is pending)and we decided, a full dose steroid (metil-prednisolone 80 mg a day) treatment for 12 days followed by gradual lowering of the dose up to 16 mg a day but after few days at these dosage pleural effusion showed up again with the need to repeat thoracentesis.
Now the inflammatory disease is under control with a daily dose of 20 mg. In the meanwhile there has been an increase in the number of neoplastic B cells in the peripheral blood (total count now is 63000/mm3), and tretment with daily dose of 10 mg chlorambucil have been started.
What may be done to stop this Dressler syndrome or post pericardiotomy syndrome ?