A case of Dressler's syndrome successfully treated with colchicine and acetaminophen. Issue 3 (March 2021)

• Record Type: Journal Article
• Authors: Nomoto, Fumika; Suzuki, Sho; Hashizume, Naoto; Kanzaki, Yusuke; Maruyama, Takuya; Kozuka, Ayako; Saigusa, Tatsuya; Ebisawa, Soichiro; Okada, Ayako; Motoki, Hirohiko; Yahikozawa, Kumiko; Kuwahara, Koichiro
• Is Part Of: Journal of cardiology cases. Volume 23:Issue 3(2021)
• Page Start: 131
• Page End: 135
• Publication Date: 2021-03
• Subjects: Dressler's syndrome -- Acute pericarditis -- Colchicine -- Recent myocardial infarction; Cardiology -- Periodicals; Cardiovascular Diseases -- Case Reports; Cardiovascular Diseases -- Periodicals; Cardiology -- Case Reports; Cardiology -- Periodicals; Cardiology; Electronic journals; Periodicals; 616.12
• DOI: 10.1016/j.jccase.2020.10.019
• Languages: English
• ISSNs: 1878-5409

Abstract

Abstract: The incidence of Dressler's syndrome after myocardial infarction (MI) has decreased in the reperfusion therapy era. Although guidelines recommend high-dose aspirin for treatment based on evidence from the pre-percutaneous coronary intervention (pre-PCI) era, bleeding and thrombotic concerns occurred upon aspirin administration after coronary stenting. A 69-year-old man with recent MI was admitted to our hospital. The patient presented with chest pain 1 week before admission. Electrocardiography revealed newly detected atrial fibrillation with no ST segment change. Urgent coronary angiography demonstrated a left circumflex artery occlusion. He underwent PCI, and a sirolimus-eluting stent was deployed. Aspirin, prasugrel, and apixaban were administered. However, hospital discharge was delayed because he developed heart failure during hospitalization. Twenty-three days after admission, he developed a fever of >39 °C. Electrocardiography showed anterior ST segment elevation, and echocardiography revealed a 6-mm pericardial effusion. We diagnosed the patient with Dressler's syndrome, and colchicine 0.5 mg/day + acetaminophen 2000 mg/day were administered. His condition clinically improved after treatment and he was discharged 32 days after admission. There was hesitation about administration of high-dose aspirin in a patient who has undergone recent coronary stenting. Combination therapy of colchicine and acetaminophen could be a treatment option for Dressler's syndrome. <Learning objective: Guidelines recommend high-dose aspirin for the treatment of Dressler's syndrome based on evidence from the pre-percutaneous coronary intervention (pre-PCI) era. However, bleeding and thrombotic concerns are present upon high-dose aspirin administration in patients who have undergone PCI. Therefore, a combination therapy of low-dose colchicine and acetaminophen could be a treatment option for patients with Dressler's syndrome who have undergone recent coronary stenting.>