Post-Pericardiotomy Syndrome Following Mitral Valve Replacement Surgery in a Patient with Rheumatic Fever: A Case Report

Background: Post-cardiac injury syndrome (PCIS) is an inflammatory condition triggered by immune responses following cardiac injury. PCIS encompasses post-myocardial pericarditis, post-pericardiotomy syndrome (PPS), and post-traumatic pericarditis, whether iatrogenic or not. In this case report, we describe a patient who developed PPS after undergoing mitral valve replacement surgery. Case presentation: A young African woman with mitral stenosis caused by rheumatic fever underwent successful mitral valve replacement surgery. Approximately one month later, she developed post-pericardiotomy syndrome, which was subsequently diagnosed and treated. The patient initially presented to the hospital with exertional dyspnoea, and echocardiography revealed severe mitral stenosis, leading to the scheduling of surgery. While awaiting the procedure, she developed atrial fibrillation (AF) and congestive heart failure. In 2022, she underwent mitral valve replacement surgery and was discharged one week later after experiencing a smooth recovery. Two weeks after discharge, she visited the emergency department due to shortness of breath, but no concerning signs were found upon examination. She was prescribed diuretics and discharged. One week later, she was admitted to the hospital again due to chest pain, dyspnoea, and an elevated C-reactive protein (CRP) level of 123. Echocardiography and chest computed tomography (CT) scans were normal. She was treated with antibiotics under suspicion of pneumonia and subsequently discharged. Ten days later, she returned to the emergency department with high fever, chest pain, and dyspnea, and her CRP level had risen to 240. Echocardiography revealed no signs of endocarditis or pericardial effusion. Considering the patient's surgical history and frequent hospitalizations for similar symptoms, PPS was suspected. The patient was administered a first-line treatment of colchicine 0.5mg once a day. As a result, CRP levels decreased, fever and chest pain resolved, and she was discharged in a stable condition. A month later she was re-admitted to the hospital due to PPS relapse, Colchicine dose was elevated to 1mg a day and was discharged in good condition. Colchicine was planned to be continued for six months. Conclusion: PPS is a common complication following open-heart surgery, characterized by a generally mild course but with the potential for severe complications. Treatment typically involves anti-inflammatory agents, aspirin, and colchicine. The recurrence rate is approximately 10-15%. Early diagnosis and treatment of PPS can minimize frequent hospitalizations and reduce the need for extensive testing