Treatment with indomethacin in a 47-year-old male with cough-variant asthma and near-tamponade resulted in resolution of respiratory symptoms and near-complete resolution of pericardial effusion.
Case Report (n=1)
This case highlights that asthma-associated systemic inflammation should be considered in the differential diagnosis of otherwise idiopathic pericardial effusion.
Abstract Introduction Pericardial effusion represents an abnormal accumulation of fluid within the pericardial sac and may arise from a broad spectrum of etiologies, including infection, malignancy, autoimmune disease, heart or renal failure, cirrhosis, hypothyroidism, myocardial infarction, radiation therapy, and certain medications. Despite extensive evaluation, up to 48% of pericardial effusions are categorized as idiopathic.Asthma is a chronic inflammatory disorder of the airways mediated predominantly by type 2 inflammation, characterized by cytokine-driven eosinophilic infiltration and elevated IgE levels. Although pericardial involvement is rare, systemic spillover of airway inflammation may extend beyond the lungs. We describe a case of cough-variant asthma complicated by significant pericardial effusion. Case Presentation A 47-year-old man with moderate persistent asthma presented with a five-day history of worsening cough and dyspnea associated with orthopnea and left-sided chest discomfort. He was afebrile with blood pressure 99/60 mmHg, heart rate 99 beats/min, and respiratory rate 26 breaths/min. Laboratory evaluation revealed normal complete blood count and basic metabolic panel, but markedly elevated CRP (244 mg/L) and ESR (51 mm/hr). TSH was normal.Computed tomography of the chest demonstrated a moderate circumferential pericardial effusion without pulmonary infiltrates. Autoimmune testing (ANA, ANCA, rheumatoid factor, anti-CCP) and infectious studies, including COVID-19, were negative. Transthoracic echocardiography showed preserved left-ventricular systolic function (ejection fraction 55-60%) with moderate circumferential pericardial effusion and early signs of effusive-constrictive physiology—subtle septal bounce, annulus reversus, and a dilated inferior vena cava.He was treated with indomethacin, resulting in resolution of his respiratory symptoms, normalization of inflammatory markers, and near-complete resolution of pericardial effusion on follow-up echocardiography. In the absence of infectious, autoimmune, or metabolic causes, the pericardial effusion was attributed to systemic inflammatory activity related to his cough-variant asthma. Discussion Pericardial effusion is an exceedingly uncommon extrapulmonary manifestation of asthma. The proposed mechanism involves extension of type 2 eosinophilic inflammation from the bronchial mucosa to systemic tissues, including the pericardium, through cytokines such as IL-4, IL-5, and IL-13. These mediators promote vascular permeability and tissue eosinophilia, potentially leading to pericardial inflammation and effusion. In our patient, an extensive infectious, autoimmune, and metabolic workup was negative, and no alternative etiology was identified despite thorough evaluation. Previous case reports have described similar occurrences of pericardial effusion and even pericarditis temporally related to asthma exacerbations or eosinophilic airway inflammation, supporting this potential association. This case highlights the need to consider asthma-associated systemic inflammation in the differential diagnosis of otherwise idiopathic pericardial effusion. This abstract is funded by: None
Phang et al. (2026) conducted a case report in Cough-variant asthma with pericardial effusion (n=1). Indomethacin was evaluated on Resolution of respiratory symptoms, normalization of inflammatory markers, and near-complete resolution of pericardial effusion. Treatment with indomethacin in a 47-year-old male with cough-variant asthma and near-tamponade resulted in resolution of respiratory symptoms and near-complete resolution of pericardial effusion.