Constrictive Pericarditis and Bilateral Pleural Effusions Unmasked in an HLA-B27 Positive Patient.

backgroundConstrictive pericarditis (CP) is most often idiopathic, postviral, postoperative, or autoimmune in etiology. HLA-B27 is strongly associated with spondyloarthropathies, which may have cardiac manifestations including conduction system abnormalities and aortopathy; however, an association with CP is not well described. CASE SUMMARY: A 40-year-old previously healthy man presented with progressive dyspnea, fevers, and cough. Initial imaging demonstrated acute pericarditis with subsequent progression to constrictive physiology. Extensive evaluation was unremarkable except for HLA-B27 positivity. He failed medical therapy and underwent radical pericardiectomy with symptom resolution. Pathology confirmed fibrous pericarditis. DISCUSSION: This case suggests a potential autoinflammatory role of HLA-B27 in the development of CP. Although HLA-B27 is known to drive chronic inflammation in spondyloarthropathies, and these conditions have established cardiac manifestations, its relationship to pericardial disease remains poorly defined. TAKE-HOME MESSAGE: In otherwise idiopathic cases of CP, isolated HLA-B27 positivity may represent a potential predisposing factor warranting further investigation.