www.pneumonologia.viamedica.pl CASE REPORT 215 Corresponding author: Corresponding author: Corresponding author: Corresponding author: Corresponding author: Prof. Monika Szturmowicz, MD, PhD, The Institute of Tuberculosis and Lung Diseases, Plocka St. 26, 01–138 Warsaw, Poland; tel.: +48 22 431 2154; fax: +48 22 431 2414; e-mail: monika.szturmowicz@gmail.com Received on 22 October 2010 Copyright © 2011 Via Medica ISSN 0867–7077 Anna Bilska 1 , Ewelina Wilińska 1 , Monika Szturmowicz 1 , Liliana Wawrzyńska 1 , Anna Fijałkowska 1 , Karina Oniszh 1 , Andrzej Światowiec 3 , Agnieszka Wsół 3 , Adam Torbicki 1 1 Department of the Internal Diseases of the Chest, The Institute of Tuberculosis and Lung Diseases, Warsaw, Poland Head: Prof. A. Torbicki, MD, PhD 2 Department of Radiology, The Institute of Tuberculosis and Lung Diseases, Warsaw, Poland Head: I. Bestry, MD, PhD 3 Department of Cardiology, Hypertension and Internal Diseases, Bródno Provincial Hospital, Warsaw, Poland Head: Prof. M. Dłużniewski, MD, PhD Recurrent exudative pericarditis in the course of adult-onset Still’s disease — two case reports Abstract Exudative pericarditis is a disease of varied aetiology requiring inclusion of both infectious and non-infectious causes in its differential diagnosis. The possible diagnoses include adult-onset Still’s disease (AOSD), a rare systemic inflammatory disease of unknown aetiology. AOSD typically develops in patients between 16 and 35 years of age and is characterised by fever, arthralgia, transient salmon-coloured rash and other abnormalities including pharyngitis, serositis (particularly pleuritis and pericarditis) and laboratory abnormalities, such as elevated white blood cell count and elevated markers of inflamma- tion. We report two cases of AOSD with recurrent exudative pericarditis. Key words: adult-onset Still’s disease, pericarditis, diagnosis, treatment Pneumonol. Alergol. Pol. 2011; 79, 3: 215–221 Introduction Exudative pericarditis is a heterogenous gro- up of diseases whose common feature is the accu- mulation of fluid in the pericardial sac, mainly as a result of inflammation of the pericardial mem- branes initiated by various aetiological factors. Infectious causes should always be looked for in cases of pericarditis accompanied by severe sys- temic symptoms, high fever and progressive dete- rioration of the patient’s condition [1]. Similarly, a fulminant course of pericarditis can also seen in cancer (especially in haematopoietic malignancies) [1, 2]. Other causes of acute exudative pericarditis include connective tissue diseases, autoimmunisa- tion-related pericardial complications of myocardial infarction and post-pericardiotomy syndrome [1–3]. We report two cases of recurrent exudative pericarditis in young men diagnosed with adult- onset Still’s disease (AOSD). Case 1 In the middle of May 2007 a 17-year-old pa- tient developed symptoms of infection with mala- ise, sore throat and cervical lymphadenopathy. Despite the prescribed outpatient empirical anti- biotic therapy the symptoms exacerbated in June 2007 with fever of up to 39°C and non-specific chest pain. An echocardiogram revealed pleural effusion with signs of impending tamponade in the form of collapse of the right ventricular and right atrial free walls. A total of 600 ml of serous fluid was evacuated, which was not sent for testing. The