Cholesterol Pericarditis: a Rare Case Report

Cholesterol Pericarditis: a Rare Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Cholesterol Pericarditis: a Rare Case Report Mohammad Saquib Alam, Khwaja Saifullah Zafar This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6000907/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Cholesterol pericarditis, or pericardial xanthoma, is a rare pericardial condition characterized by cholesterol crystal accumulation within the pericardium [ 1 ]. It is associated with hyperlipidemia, rheumatoid arthritis, hypothyroidism, and other cardiovascular risk factors [ 1 ], [ 2 ]. While the exact mechanisms remain unclear, chronic inflammation and lipid metabolism abnormalities are implicated [ 2 ]. This report describes the case of a 50-year-old female with hypercholesterolemia who presented with progressive dyspnea, chest pain, and fatigue. Diagnostic evaluation revealed massive pericardial effusion with cholesterol crystals but no infection or malignancy. The patient was successfully treated with pericardiocentesis, NSAIDs, and lipid-lowering therapy, achieving rapid symptom resolution. This case underscores the importance of considering cholesterol pericarditis in patients with unexplained pericardial effusion, especially those with dyslipidemia, and highlights effective management strategies for this rare condition. Cardiac & Cardiovascular Systems Pericarditis Cholesterol TB Xanthogranulomatous Pericarditis Figures Figure 1 1. Introduction Pericarditis, or inflammation of the pericardium, can have diverse etiologies, including infectious, autoimmune, neoplastic, and metabolic causes [ 3 ]. Cholesterol pericarditis, also known as xanthogranulomatous pericarditis, is a rare form of pericardial disease characterized by the deposition of cholesterol crystals within the pericardium. This condition was first described over a century ago and remains poorly understood due to its rarity. Pathophysiology involves chronic inflammation and lipid metabolism abnormalities, leading to crystal deposition and recurrent effusion [ 3 ], [ 4 ]. This report presents a case of cholesterol pericarditis, illustrating its clinical presentation, diagnostic evaluation, and management, while emphasizing the importance of early recognition and treatment. 2. Case Presentation Initial Presentation A 50-year-old female, without known chronic illnesses, presented to the emergency department with progressive dyspnea on exertion (NYHA Class II to III over three months) and fatigue. She also reported chest discomfort but denied fever, weight loss, or other systemic symptoms. She had been treated empirically with antitubercular therapy for suspected tubercular pericarditis, which failed to alleviate her symptoms. Examination On physical examination, the patient appeared uncomfortable but not in acute distress. Raised jugular venous pressure and distant heart sounds were noted, while the lung examination was unremarkable. Vital signs were stable. Diagnostic Workup Electrocardiogram (ECG): Low-voltage QRS complexes and electrical alternans (Fig 1A). Chest X-ray: Massive pericardial effusion with an enlarged cardiac silhouette (Fig 1C). Echocardiography: Confirmed large pericardial effusion with signs of inflammation but no tamponade. Pericardiocentesis was performed, draining 1.5L of golden-yellow fluid, which was sent for analysis. Microscopic examination revealed multiple cholesterol crystals, confirming the diagnosis of cholesterol pericarditis. Laboratory investigations ruled out infection, malignancy, and autoimmune conditions. Laboratory Findings Pericardial Fluid Analysis: · Color: Golden yellow · Protein: 4.2 g/dL, Cholesterol: 112 mg/dL · Differential Cell Count: Lymphocytes 80%, PMN 20% · Gram and ZN Stains Negative Serum Investigations: · Elevated CRP: 32 mg/L · Lipid Profile: Total cholesterol 240 mg/dL, LDL 210 mg/dL, HDL 30 mg/dL, Triglycerides 240 mg/dL · Rheumatologic and thyroid profiles: Within normal limits Image Findings Figures 1 illustrate ECG, chest X-ray, and microscopic findings before and after pericardiocentesis, showing normalization of QRS complexes and reduction in cardiac silhouette size following fluid drainage. 3. Management & Follow up The patient was treated with a combination of: 1. NSAIDs and Colchicine: To reduce inflammation. 2. High-Dose Statins: To address underlying dyslipidemia. Symptoms improved significantly during hospitalization, and the patient was discharged in stable condition. Follow-up at one and three months showed no recurrence of symptoms, although she was lost to follow-up thereafter. Long-term lipid control was emphasized to prevent recurrence. 4. Discussions Cholesterol pericarditis is an exceedingly rare condition with only a handful of reported cases. It is often associated with dyslipidemia and other metabolic or inflammatory disorders. The clinical presentation mimics other forms of pericarditis, necessitating a high index of suspicion. Diagnosis hinges on the identification of cholesterol crystals in pericardial fluid, alongside exclusion of common causes such as tuberculosis, autoimmune diseases, and malignancy [ 5 ]. The pathogenesis of cholesterol pericarditis involves the deposition of cholesterol crystals within the pericardium, leading to an inflammatory response and subsequent pericardial thickening [ 2 ], [ 6 ]. The clinical presentation is often like other forms of pericarditis, with chest pain, dyspnea, and friction rub being common features. The diagnosis of cholesterol pericarditis can be challenging, as it requires a high index of suspicion and confirmation through pericardial fluid analysis. Cholesterol pericarditis can be mistaken for other conditions, as seen in this case where tuberculosis was initially suspected. Comprehensive fluid analysis is pivotal for accurate diagnosis. Microscopic examination of pericardial fluid reveals cholesterol clefts and multinucleated giant cells, characteristic of xanthogranulomatous inflammation [ 3 ]. Echocardiography plays a crucial role in detecting pericardial effusion and assessing the hemodynamic impact. A multimodal approach is essential for effective management, combining several therapeutic strategies. Anti-inflammatory therapy, including NSAIDs and colchicine, plays a pivotal role in providing symptom relief and controlling inflammation. Lipid-lowering agents, particularly statins, are crucial for addressing dyslipidemia and reducing the risk of recurrence. In cases of symptomatic effusion, pericardiocentesis may be necessary to provide immediate relief. Early intervention is vital to prevent potential complications, such as constrictive pericarditis. Cholesterol pericarditis is a rare manifestation of recurrent pericardial disease that requires prompt recognition and appropriate management. Further studies are needed to understand the long-term outcomes and optimal management strategies for cholesterol pericarditis, including the role of aggressive lipid control and recurrence monitoring. This case highlights the importance of recognizing cholesterol pericarditis as a potential cause of pericardial effusion in patients with dyslipidemia. Prompt diagnosis through fluid analysis and a tailored treatment approach involving anti-inflammatory and lipid-lowering therapies can lead to successful management and prevention of complications. Declarations I confirm that written informed consent was obtained from the patient for participation and publication of this case report. References S. Shergill, J. Davies, and N. Cairns, “Effusive-constrictive cholesterol pericarditis: a case report,” Eur. Heart J. Case Rep. , vol. 5, no. 1, p. ytaa496, Jan. 2021, doi: 10.1093/ehjcr/ytaa496. T. Khawaja, R. Feroze, and B. D. Hoit, “Cholesterol Pericarditis,” JACC Case Rep. , vol. 4, no. 13, pp. 808–813, Jul. 2022, doi: 10.1016/j.jaccas.2022.04.001. R. K. Brawley, J. S. Vasko, and A. G. Morrow, “Cholesterol pericarditis: Considerations of its pathogenesis and treatment,” Am. J. Med. , vol. 41, no. 2, pp. 235–248, Aug. 1966, doi: 10.1016/0002-9343(66)90019-2. A. Vijayanarayanan and M. P. Menon, “Cholesterol Pericarditis,” N. Engl. J. Med. , vol. 387, no. 11, pp. 1021–1021, Sep. 2022, doi: 10.1056/NEJMicm2118193. T. S. Kafil et al. , “Aggressive Cholesterol Pericarditis With Minimal Effusion Masquerading as Treatment-Refractory Autoimmune Disease,” CJC Open , vol. 4, no. 2, pp. 237–239, Sep. 2021, doi: 10.1016/j.cjco.2021.09.018. J. S. Alexander, “A PERICARDIAL EFFUSION OF ‘GOLD-PAINT’ APPEARANCE DUE TO THE PRESENCE OF CHOLESTERIN,” Br. Med. J. , vol. 2, no. 3067, p. 463, Oct. 1919, doi: 10.1136/bmj.2.3067.463. Tables Table 1. Pericardial Fluid Analysis Pericardial Fluid Analysis Color Golden Yellow Appearance Slight Turbid Protein 4.2 g/dL Albumin 3.0 g/dL Sugar 127 g/dL Chloride 590 mg/dL Specific Gravity 1018 Total Cell Count 105/mL Differential Cell Count PMN 20 %; Lymphocytes 80% ADA 9.8 Gram Stain Negative ZN Stain Negative Misc. Multiple Cholesterol Crystals Cholesterol 112 mg/dL (Range <70 mg/dL) Table 2. Laboratory Investigations Lab Investigations RA Factor 10.4 (<14) Anti CCP 1.6 (<5) CRP 37.6 (0-5) ANA Not Detected Anti dsDNA 5.10 (<20) IGRA MTB Negative TSH 3.4 Hba1c 6.9 % Lipid Profile TAG-240 mg/dL; Cholesterol-240 mg/dL; LDL-210 mg/dL; HDL-30 mg/dL Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6000907","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":413782219,"identity":"b6f9d6a8-6b43-49d7-9e7a-4f5e79bbceef","order_by":0,"name":"Mohammad Saquib Alam","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7UlEQVRIiWNgGAWjYHACxgMMDBI8/OwNCKEDhPQAFVjISfYcQBEhqKXC2OBGApGu0u0//ODAzxyJxA03X6dJ/Mw5zMDffoDxcAEeLWY30gwO9m6TSJx5O3ebZO+2wwwSZxIYDs/Aq4XB4AAvUEsfUIsEL1ALww0GhsM8+LScP/7h4F+gloabZ7dJ/gVqkSeo5UCOwWGgLcYCN3i3SYNsMSCo5UZOwWHZbRLAQM7dbC27LZ3H8ExiAyGHbXz4dlsdMCrPbrz5dpu1nNzxw4c/49OCDFgkgARQMWMDkRoYGJg/EK10FIyCUTAKRhQAAMOpV281zNyDAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0009-0006-7444-6592","institution":"Aligarh Muslim University","correspondingAuthor":true,"prefix":"","firstName":"Mohammad","middleName":"Saquib","lastName":"Alam","suffix":""},{"id":413782220,"identity":"4b80f42b-8b97-44cf-90b7-78459de11293","order_by":1,"name":"Khwaja Saifullah Zafar","email":"","orcid":"","institution":"Aligarh Muslim University","correspondingAuthor":false,"prefix":"","firstName":"Khwaja","middleName":"Saifullah","lastName":"Zafar","suffix":""}],"badges":[],"createdAt":"2025-02-10 16:37:44","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":true,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6000907/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6000907/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":76278756,"identity":"7c950768-d738-4da0-bf9d-38fbc2c50587","added_by":"auto","created_at":"2025-02-14 10:19:02","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":524671,"visible":true,"origin":"","legend":"\u003cp\u003eElectrocardiogram (ECG) and chest X-ray imaging before and after pericardiocentesis. \u003cstrong\u003ePanel A (ECG before pericardiocentesis)\u003c/strong\u003e: Demonstrates low-voltage QRS complexes and electrical alternans, indicative of a significant pericardial effusion. \u003cstrong\u003ePanel B (ECG after pericardiocentesis)\u003c/strong\u003e: Shows normalization of QRS voltage and resolution of electrical alternans following drainage of the pericardial effusion. \u003cstrong\u003ePanel C (Chest X-ray before pericardiocentesis)\u003c/strong\u003e: Reveals a massive pericardial effusion causing an enlarged cardiac silhouette and blunted costophrenic angles. \u003cstrong\u003ePanel D (Chest X-ray after pericardiocentesis)\u003c/strong\u003e: Shows significant reduction in cardiac silhouette size and improvement in lung fields following pericardial fluid drainage.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6000907/v1/b42414bfcf170eb2b8d5d37d.png"},{"id":76280242,"identity":"bdb75d6d-e269-41d4-8b49-432a34d3c367","added_by":"auto","created_at":"2025-02-14 10:27:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1133999,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6000907/v1/8d1c0776-70e3-4945-9d14-6a37ed204af0.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eCholesterol Pericarditis: a Rare Case Report\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003ePericarditis, or inflammation of the pericardium, can have diverse etiologies, including infectious, autoimmune, neoplastic, and metabolic causes [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Cholesterol pericarditis, also known as xanthogranulomatous pericarditis, is a rare form of pericardial disease characterized by the deposition of cholesterol crystals within the pericardium. This condition was first described over a century ago and remains poorly understood due to its rarity. Pathophysiology involves chronic inflammation and lipid metabolism abnormalities, leading to crystal deposition and recurrent effusion [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This report presents a case of cholesterol pericarditis, illustrating its clinical presentation, diagnostic evaluation, and management, while emphasizing the importance of early recognition and treatment.\u003c/p\u003e"},{"header":"2. Case Presentation","content":"\u003cp\u003e\u003cstrong\u003eInitial Presentation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA 50-year-old female, without known chronic illnesses, presented to the emergency department with progressive dyspnea on exertion (NYHA Class II to III over three months) and fatigue. She also reported chest discomfort but denied fever, weight loss, or other systemic symptoms. She had been treated empirically with antitubercular therapy for suspected tubercular pericarditis, which failed to alleviate her symptoms.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExamination\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOn physical examination, the patient appeared uncomfortable but not in acute distress. Raised jugular venous pressure and distant heart sounds were noted, while the lung examination was unremarkable. Vital signs were stable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiagnostic Workup\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eElectrocardiogram (ECG):\u003c/strong\u003e Low-voltage QRS complexes and electrical alternans (Fig 1A).\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eChest X-ray:\u003c/strong\u003e Massive pericardial effusion with an enlarged cardiac silhouette (Fig 1C).\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eEchocardiography:\u003c/strong\u003e Confirmed large pericardial effusion with signs of inflammation but no tamponade.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003ePericardiocentesis was performed, draining 1.5L of golden-yellow fluid, which was sent for analysis. Microscopic examination revealed multiple cholesterol crystals, confirming the diagnosis of cholesterol pericarditis. Laboratory investigations ruled out infection, malignancy, and autoimmune conditions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLaboratory Findings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePericardial Fluid Analysis:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026middot; Color: Golden yellow\u003c/p\u003e\n\u003cp\u003e\u0026middot; Protein: 4.2 g/dL, Cholesterol: 112 mg/dL\u003c/p\u003e\n\u003cp\u003e\u0026middot; Differential Cell Count: Lymphocytes 80%, PMN 20%\u003c/p\u003e\n\u003cp\u003e\u0026middot; Gram and ZN Stains Negative\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSerum Investigations:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026middot; Elevated CRP: 32 mg/L\u003c/p\u003e\n\u003cp\u003e\u0026middot; Lipid Profile: Total cholesterol 240 mg/dL, LDL 210 mg/dL, HDL 30 mg/dL, Triglycerides 240 mg/dL\u003c/p\u003e\n\u003cp\u003e\u0026middot; Rheumatologic and thyroid profiles: Within normal limits\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImage Findings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFigures 1 illustrate ECG, chest X-ray, and microscopic findings before and after pericardiocentesis, showing normalization of QRS complexes and reduction in cardiac silhouette size following fluid drainage.\u003c/p\u003e"},{"header":"3. Management \u0026 Follow up","content":"\u003cp\u003eThe patient was treated with a combination of:\u003c/p\u003e\n\u003cp\u003e1. \u003cstrong\u003eNSAIDs and Colchicine:\u003c/strong\u003e To reduce inflammation.\u003c/p\u003e\n\u003cp\u003e2. \u003cstrong\u003eHigh-Dose Statins:\u003c/strong\u003e To address underlying dyslipidemia.\u003c/p\u003e\n\u003cp\u003eSymptoms improved significantly during hospitalization, and the patient was discharged in stable condition. Follow-up at one and three months showed no recurrence of symptoms, although she was lost to follow-up thereafter. Long-term lipid control was emphasized to prevent recurrence.\u003c/p\u003e"},{"header":"4. Discussions","content":"\u003cp\u003eCholesterol pericarditis is an exceedingly rare condition with only a handful of reported cases. It is often associated with dyslipidemia and other metabolic or inflammatory disorders. The clinical presentation mimics other forms of pericarditis, necessitating a high index of suspicion. Diagnosis hinges on the identification of cholesterol crystals in pericardial fluid, alongside exclusion of common causes such as tuberculosis, autoimmune diseases, and malignancy [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe pathogenesis of cholesterol pericarditis involves the deposition of cholesterol crystals within the pericardium, leading to an inflammatory response and subsequent pericardial thickening [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The clinical presentation is often like other forms of pericarditis, with chest pain, dyspnea, and friction rub being common features. The diagnosis of cholesterol pericarditis can be challenging, as it requires a high index of suspicion and confirmation through pericardial fluid analysis. Cholesterol pericarditis can be mistaken for other conditions, as seen in this case where tuberculosis was initially suspected. Comprehensive fluid analysis is pivotal for accurate diagnosis. Microscopic examination of pericardial fluid reveals cholesterol clefts and multinucleated giant cells, characteristic of xanthogranulomatous inflammation [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Echocardiography plays a crucial role in detecting pericardial effusion and assessing the hemodynamic impact.\u003c/p\u003e \u003cp\u003eA multimodal approach is essential for effective management, combining several therapeutic strategies. Anti-inflammatory therapy, including NSAIDs and colchicine, plays a pivotal role in providing symptom relief and controlling inflammation. Lipid-lowering agents, particularly statins, are crucial for addressing dyslipidemia and reducing the risk of recurrence. In cases of symptomatic effusion, pericardiocentesis may be necessary to provide immediate relief. Early intervention is vital to prevent potential complications, such as constrictive pericarditis.\u003c/p\u003e \u003cp\u003eCholesterol pericarditis is a rare manifestation of recurrent pericardial disease that requires prompt recognition and appropriate management. Further studies are needed to understand the long-term outcomes and optimal management strategies for cholesterol pericarditis, including the role of aggressive lipid control and recurrence monitoring. This case highlights the importance of recognizing cholesterol pericarditis as a potential cause of pericardial effusion in patients with dyslipidemia. Prompt diagnosis through fluid analysis and a tailored treatment approach involving anti-inflammatory and lipid-lowering therapies can lead to successful management and prevention of complications.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eI confirm that written informed consent was obtained from the patient for participation and publication of this case report.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eS. Shergill, J. Davies, and N. Cairns, \u0026ldquo;Effusive-constrictive cholesterol pericarditis: a case report,\u0026rdquo; \u003cem\u003eEur. Heart J. Case Rep.\u003c/em\u003e, vol. 5, no. 1, p. ytaa496, Jan. 2021, doi: 10.1093/ehjcr/ytaa496.\u003c/li\u003e\n \u003cli\u003eT. Khawaja, R. Feroze, and B. D. Hoit, \u0026ldquo;Cholesterol Pericarditis,\u0026rdquo; \u003cem\u003eJACC Case Rep.\u003c/em\u003e, vol. 4, no. 13, pp. 808\u0026ndash;813, Jul. 2022, doi: 10.1016/j.jaccas.2022.04.001.\u003c/li\u003e\n \u003cli\u003eR. K. Brawley, J. S. Vasko, and A. G. Morrow, \u0026ldquo;Cholesterol pericarditis: Considerations of its pathogenesis and treatment,\u0026rdquo; \u003cem\u003eAm. J. Med.\u003c/em\u003e, vol. 41, no. 2, pp. 235\u0026ndash;248, Aug. 1966, doi: 10.1016/0002-9343(66)90019-2.\u003c/li\u003e\n \u003cli\u003eA. Vijayanarayanan and M. P. Menon, \u0026ldquo;Cholesterol Pericarditis,\u0026rdquo; \u003cem\u003eN. Engl. J. Med.\u003c/em\u003e, vol. 387, no. 11, pp. 1021\u0026ndash;1021, Sep. 2022, doi: 10.1056/NEJMicm2118193.\u003c/li\u003e\n \u003cli\u003eT. S. Kafil \u003cem\u003eet al.\u003c/em\u003e, \u0026ldquo;Aggressive Cholesterol Pericarditis With Minimal Effusion Masquerading as Treatment-Refractory Autoimmune Disease,\u0026rdquo; \u003cem\u003eCJC Open\u003c/em\u003e, vol. 4, no. 2, pp. 237\u0026ndash;239, Sep. 2021, doi: 10.1016/j.cjco.2021.09.018.\u003c/li\u003e\n \u003cli\u003eJ. S. Alexander, \u0026ldquo;A PERICARDIAL EFFUSION OF \u0026lsquo;GOLD-PAINT\u0026rsquo; APPEARANCE DUE TO THE PRESENCE OF CHOLESTERIN,\u0026rdquo; \u003cem\u003eBr. Med. J.\u003c/em\u003e, vol. 2, no. 3067, p. 463, Oct. 1919, doi: 10.1136/bmj.2.3067.463.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1. Pericardial Fluid Analysis\u003c/p\u003e\n\u003cdiv align=\"Left\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003ePericardial Fluid Analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eColor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eGolden Yellow\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eAppearance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eSlight Turbid\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eProtein\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e4.2 g/dL\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eAlbumin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e3.0 g/dL\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eSugar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e127 g/dL\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eChloride\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e590 mg/dL\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eSpecific Gravity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e1018\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eTotal Cell Count\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e105/mL\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eDifferential Cell Count\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003ePMN 20 %; Lymphocytes 80%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eADA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e9.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eGram Stain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eZN Stain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMisc.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003eMultiple Cholesterol Crystals\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eCholesterol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e112 mg/dL (Range \u0026lt;70 mg/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable 2. Laboratory Investigations\u003c/p\u003e\n\u003cdiv align=\"Left\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 414px;\"\u003e\n \u003cp\u003eLab Investigations\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eRA Factor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e10.4 (\u0026lt;14)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eAnti CCP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e1.6 (\u0026lt;5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eCRP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e37.6 (0-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eANA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003eNot Detected\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eAnti dsDNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e5.10 (\u0026lt;20)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eIGRA MTB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eTSH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eHba1c\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003e6.9 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eLipid Profile\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003eTAG-240 mg/dL; Cholesterol-240 mg/dL; LDL-210 mg/dL; HDL-30 mg/dL\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Aligarh Muslim University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Pericarditis, Cholesterol, TB, Xanthogranulomatous Pericarditis","lastPublishedDoi":"10.21203/rs.3.rs-6000907/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6000907/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eCholesterol pericarditis, or pericardial xanthoma, is a rare pericardial condition characterized by cholesterol crystal accumulation within the pericardium [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It is associated with hyperlipidemia, rheumatoid arthritis, hypothyroidism, and other cardiovascular risk factors [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. While the exact mechanisms remain unclear, chronic inflammation and lipid metabolism abnormalities are implicated [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. This report describes the case of a 50-year-old female with hypercholesterolemia who presented with progressive dyspnea, chest pain, and fatigue. Diagnostic evaluation revealed massive pericardial effusion with cholesterol crystals but no infection or malignancy. The patient was successfully treated with pericardiocentesis, NSAIDs, and lipid-lowering therapy, achieving rapid symptom resolution. This case underscores the importance of considering cholesterol pericarditis in patients with unexplained pericardial effusion, especially those with dyslipidemia, and highlights effective management strategies for this rare condition.\u003c/p\u003e","manuscriptTitle":"Cholesterol Pericarditis: a Rare Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-14 10:18:58","doi":"10.21203/rs.3.rs-6000907/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f427556f-00f6-447e-9431-24e946e76c06","owner":[],"postedDate":"February 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":44319970,"name":"Cardiac \u0026 Cardiovascular Systems"}],"tags":[],"updatedAt":"2025-02-14T10:18:58+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-14 10:18:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6000907","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6000907","identity":"rs-6000907","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}