Hemorrhagic pericardial effusion following treatment with infliximab: A case report and literature review

Table 1 Infliximab-associated pericardial complications reported in the literature including the present case

Cases	Age (yr)	Gender	Primary disease	Pericardial complications	Clinical presentation	Duration of IFX Treatment	Follow-up treatment	Outcome
1	68	Female	RA	Transudate, constrictive	Right heart failure: leg edema and anorexia	40 d	Infliximab discontinuation, pericardiocentesis	Pericardial effusion not increased
2	57	Female	RA	Hemorrhagic	Shortness of breath, right heart failure	14 mo	Pericardiocentesis	Recurrent disease, pericardiectomy
3	70	Female	RA	Infective pericarditis	Cardiac failure, fatigue, dyspnea	6 yr	Stop etanercept, pericardiocentesis and pericardial drain, antibiotics	White cell count normalized, CRP fallen
4	75	Female	RA	-	Dyspnea	4 yr	Steroid	Readmitted with recurrent symptoms, pericardiocentesis
5	60	Female	RA	-	Cardiovascular collapse	4 mo	Pericardiocentesis, steroid	Clinical symptoms and pericardial effusion improved
6	45	Male	RA	Hemorrhagic, DILE	Fever, cough, polyarthralgia, chest pain	22 wk	Infliximab discontinuation, steroid	Clinical symptoms and pericardial effusion improved
7	57	Male	RA	Purulent	Collapse	3 wk	Pericardiocentesis, antibiotics, infliximab discontinuation	Fenestration for residual pericardial effusion
8	40	Male	RA	-	Chest pain, chest discomfort	15 mo	Antibiotics, steroid	Recurrent disease, pericardiectomy
9	51	Female	UC	DILE	Chest pain, shortness of breath, fatigue	1 wk	Infliximab discontinuation, steroid	Clinical symptoms improved
10	48	Female	UC	Cardiac tamponade	Chest pain, dyspnea	1 mo	Infliximab discontinuation, pericardiocentesis, diuresis	No recurrence or persistent cardiac dysfunction
11	59	Male	UC	Non-infectious	Left-sided chest pain	1 mo	Infliximab discontinuation, NSAIDS, adalimumab	No recurrence of pericarditis
12	60	Male	UC	Hemorrhagic, cardiac tamponade	Shortness of breath, diffuse joint swelling and aches, general malaise	1 wk (infliximab was reintroduced)	Infliximab discontinuation, antibiotics	Progressive shortness of breath and recumbent chest pain, pericardiocentesis, steroid and pericardial drain were performed, pericardial effusion decreased
13	41	Male	UC	DILE, cardiac tamponade	Pleuritic chest pain, dyspnea	19 mo	Infliximab discontinuation, steroid	No residual pericardial effusion
14	30	Female	CD	Fibrinous, cardiac tamponade	Pleuritic chest pain, dyspnea	12 mo	Infliximab discontinuation, pericardial window, mediastinal chest tube, steroid	No recurrence of symptoms of pericarditis
15	57	Male	CD	Purulent, cardiac tamponade	Chest pain, fever, general malaise	8 yr	Infliximab discontinuation, pericardial window, antibiotics	Asymptomatic
16	39	Male	CD	DILE	Pleuritic chest pain, nausea, weakness	8 mo	Steroid	Severe arthralgia when used infliximab one more time; no recurrence of lupus-like symptoms after infliximab discontinuation
171	27	Male	CD	Hemorrhagic	Dyspnea, fever and worsening weakness	7 wk	Infliximab discontinuation, pericardiocentesis	Clinical symptoms and pericardial effusion improved

¹Our case. CD: Crohn’s disease; DILE: Drug-induced lupus erythematosus; NSAID: Nonsteroidal anti-inflammatory drug; RA: Rheumatoid arthritis; UC: Ulcerative colitis.