Peritoneal involvement in acute pericarditis with polyserositis may mimic acute cholecystitis: a case report

Acute pericarditis is an inflammatory disease of the pericardium that can exclusively affect the pericardium or extend and affect other serosae, including the pleura and peritoneum. The involvement and dysregulation of the inflammasome, a protein complex responsible for the innate immune response, appear to be central in these forms of idiopathic pericarditis. This multi-district interest leads to considering recurrent pericarditis also as a possible systemic disease. Here, we report the case of a 56-year-old male with a negative past medical history who presented with dyspnea, chest and abdominal pain, and a low-grade fever. Routine investigations and echocardiography were consistent with acute pericarditis; a chest X-ray revealed pleural effusion, and an abdominal ultrasound detected modest peritoneal effusion and cholecystitis. The symptoms completely regressed within 24 hours of initiating therapy with non-steroidal anti-inflammatory drugs and colchicine. The pericardial, pleural, and peritoneal effusions, along with cholecystitis, regressed in the next 4 weeks. This is the first reported case in which pericarditis with polyserositis also involved the gallbladder in the inflammatory process. It appears that standard therapy for pericarditis was effective in inducing remission of the extracardiac inflammatory processes, further supporting the hypothesis of an autoinflammatory etiology for the cholecystic inflammatory process as well. Early identification of pericarditis with systemic involvement implies shorter hospitalization times and improved therapeutic classification of the patient, thereby reducing the likelihood of corticosteroid-dependent pericarditis and significantly lowering the risk of relapse.