recurrent precarditis

[RossB]

I am a 42 year old male. I had surgery to remove a carcinoid tumor from my left lung at MD Anderson this summer. The carcinoid was typical and I did not have the syndrome. Multiple tests found no evidence of metastatic process. The surgery went well and I was doing fantastic.

Eight weeks after the surgery I developed pericarditis with a large effusion. The fluid drained was tested for cancer and other organisms and came back negative. The cardiologists put me on 40mg Prednisone for five days with a three week taper. It was initially felt this was Dressler's Syndrome.

I have had three recurrences in the three months since the intial onset. NSAIDs do not work nor does Indocin. I take    Colchicine .6mg twice daily since the first recurrence and Prednisone at 40mg with taper as needed for flares. Reoccurrence seems guaranteed as the taper off Prednisone continues.

I am seeing Infectious Disease specialisists, Rheumatologists, Oncologists and have an appointment with a Gastroenterologist next week and will be scoped top to tails. I have been on PPIs twice daily since onset. All the autoimmune tests came back negative for rheumatology. TB was negative but the other infectious tests are pending. CT scans are negative for disease process. Thyroid tests are outstanding. Multiple ECHO's show normal heart function and are the only tool that has revealed the illness. Interestingly, no one has been able to hear a friction rub and my EKGs are normal even when I am symptomatic.

Pericardial window has been mentioned although specialists differ on whether necessary as my effusion has never returned in more than a minimal amount. I'm scared to death of mention of stripping after reading about that online and have been told that should be a last resort. If we run out of diagnostic options a PET scan is being considered. We may also need to do another tap to grab more fluid for additional tests and a biopsy for pathology.

Thanks for your thoughts and insight,
RossB

[Cleveland Clinic]

There is really nothing left for me to add. It sounds as if your doctors are doing an excellent job in making sure that this is in fact a non infectious effusion and also that this does not represent return of the tumor. Pericardiectomy is the ultimate treatment, but this is an extensive suregery which may have serious complications. How low a level of prednisone can you maintain before the pericarditis returns. If less than 10 mg it may be worth to simply continue it for an extended period ( months) to see if it disappears.