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Graft-versus-host disease: a case report of a rare but reversible cause of constrictive pericarditis

Pieri, CA; Roberts, N; Gribben, J; Manisty, C; (2020) Graft-versus-host disease: a case report of a rare but reversible cause of constrictive pericarditis. European Heart Journal - Case Reports , 4 (2) pp. 1-5. 10.1093/ehjcr/ytaa009. Green open access

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Abstract

BACKGROUND: Constrictive pericarditis (CP), although an uncommon cause of heart failure, requires specialist multidisciplinary input and multi-modality imaging to identify the underlying aetiology and treat potentially reversible causes. CASE SUMMARY: We report the case of a 74-year-old gentleman referred for assessment of progressive exertional dyspnoea and peripheral oedema, 30 months following treatment of acute myeloid leukaemia with high-dose chemotherapy and allogeneic stem cell transplantation. Clinical examination and cardiac imaging revealed a small pericardial effusion and pericardial thickening with constrictive physiology; however, no aetiology was identified despite diagnostic pericardiocentesis. The patient required recurrent hospital admissions for intravenous diuresis, therefore, following multidisciplinary discussions, surgical partial pericardectomy was performed. Histology suggested graft-vs.-host disease (GvHD) and post-operatively, the patient improved clinically. Following immunomodulatory therapy with ruxolitinib for both pericardial and pulmonary GvHD, his functional status improved further with no subsequent hospital admissions. DISCUSSION: Although pericardial disease in cancer patients is common, CP is unusual. Determining the underlying aetiology is important for subsequent management, and here, we describe the use of multi-modality imaging to diagnose a rare cause, GvHD, which responded to surgical treatment and immunomodulatory therapy.

Type: Article
Title: Graft-versus-host disease: a case report of a rare but reversible cause of constrictive pericarditis
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/ehjcr/ytaa009
Publisher version: https://doi.org/10.1093/ehjcr/ytaa009
Language: English
Additional information: © The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/).
Keywords: Graft-vs.-host disease, Allogeneic stem cell transplantation, Cardio-oncology, Case report, Constrictive pericarditis, Heart failure
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Clinical Science
URI: https://discovery.ucl.ac.uk/id/eprint/10097729
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