Colchicine in Treatment of Intractable Postpericardiotomy Syndrome in an Elderly Patient

Postpericardiotomy syndrome is a specific type of acute pericarditis because of a delayed pericardial and/or pleural reaction after thoracic surgery. Relapse after aspirin, nonsteroidal anti-inflammatory drug, and/or steroid treatment or intractable to this conventional therapy causes a troublesome situation. Colchicine was first proposed for treatment of recurrent pericarditis in 1987. A number of investigators have reported the efficacy and safety of colchicine in combination therapy for recurrent pericarditis. Recently, Colchicine for Recurrent Pericarditis and Colchicine for Acute Pericarditis studies suggested that colchicine is useful in the first attack of acute pericarditis, and corticosteroid therapy given in the first attack favors the recurrence of pericarditis. In this report, we present an 82-year-old woman with severe tricuspid regurgitation and moderate-to-severe mitral regurgitation because of rheumatic heart disease, postpericardiotomy syndrome with severe pleural and pericardial effusion developed after the open-heart surgery. Both pleural and pericardial effusion was intractable to steroid therapy. Colchicine and steroid combination therapy made the syndrome remission rapidly. The total course of colchicines therapy was 2.5 months. There was no recurrence after 1 year of clinic follow-up.