Drug-induced pericarditis: a systematic review of all published cases

Background: No large case series nor clinical trials on drug-induced pericarditis have been reported. This study analyses data from previously reported cases to provide a comprehensive understanding of the aetiology, clinical presentation, management strategies, and outcomes of this rare and often underestimated aetiology of pericarditis. Methods: A systematic review according to PRISMA guidelines was conducted, identifying 121 cases of drug-induced pericarditis. All references found, upon initial assessment at title and abstract level for suitability, were consequently retrieved as full reports for inclusion in this review. Results: Among the 121 cases, 37 were related to anti-cancer, immunosuppressive, immunomodulatory drugs, 27 to anti-inflammatory drugs, 33 to central nervous system agents, 10 to cardiovascular drugs and 18 to other drugs. Median age was 45 (27, 59), 38.8 % were females, the most frequent symptom was pericardial chest pain, described in 86.8 % of patients. Many patients presented associated systemic symptoms; concomitant minor myocardial involvement was found in about half of the patients. All patients were hospitalized and withdrew the drug at the time of diagnosis. Symptoms resolved in an average of 5 ± 4 days and all patients who resumed the drug experienced a new recurrence. 18 patients underwent pericardiocentesis for cardiac tamponade, 9 underwent pericardiectomy. Four patients died during the follow-up. Conclusions: Although uncommon, drug-induced pericarditis can be a life-threatening condition, causing cardiac tamponade or constrictive pericarditis. It is therefore crucial to increase awareness and knowledge of this rare aetiology of pericarditis to ensure prompt diagnosis and timely withdrawal of the causative drug.