Case Report

Prevention of High-Dose Cytosine Arabinoside-Induced Acute Pericarditis with Preemptive Dexamethasone Administration: A Case Report and Literature Review

Table 1

Reported cases of Ara-C-induced pericarditis/pericardial effusion.

AuthorYearPatients/diseaseSite of complicationChemotherapy regimen and onset of event (day after receiving chemotherapy)Treatment of pericarditis or pericardial effusionResults

Vaickus and Letendre198425-year-old man with relapsed ALLPC/PEEF with cardiac tamponadeDay 2 after the fourth dose of the second cycle of high-dose Ara-C (3 g/M2 for 10 doses/cycle) (consolidation)Prednisolone 10 mg twice daily and salicylate 500 mg twice daily for 2 days, but no response; pericardiocentesis was performedFull recovery after pericardiocentesis
Gillis et al.199251-year-old womanPC with minimal PEEFDay 3 after the fifth dose of the first cycle of high-dose Ara-C (3 g/M2 for 12 doses/cycle) (consolidation)Hydrocortisone 200 mg once daily intravenouslyFull recovery within a week without pericardiocentesis
Reykdal et al.199547-year-old man with AML-M4PC, no PEEFDay 11 after the last dose of the first cycle of high-dose Ara-C (2 g/M2 every 12 hours for 6 days) (consolidation)Supportive treatment with NSAIDsPain relieved by NSAIDs within a day
Hermans et al.199737-year-old man with AML-M2PC/PEEFDay 4 after the 5th dose of 3rd cycle of high-dose Ara-C (3 g/M2 every 12 hours for 4 days) (consolidation)Methylprednisolone 0.5 mg/kg orally for 8 days, and tapered off at day 11Complete recovery by day 7 of methylprednisolone
Yamada et al.199861-year-old man with AML-M2 and 65-year-old man with MDS-related AML-M2PEEFRelapsed AML, low-dose Ara-C (induction remission)
AML-M2 low-dose Ara-C (consolidation)
Pulse methylprednisolone plus pericardiocentesisNot reported
Woods et al.199947-year-old man with AML-M2Large PEEFDay 9 after the first induction remission with daunorubicin and Ara-C (100 mg/M2 D1-7); then, high-dose Ara-C (2 g/M2 on D8-10) (induction remission)PericardiocentesisRecovery by 6 weeks
Gähler et al.200364-year-old man with AML-M41st: PC/small PEEF1st episode: day 29 after 7 + 3 regimen (200 mg/M2 Ara-C) (induction remission)1st: NSAIDsRecovery in 48 hours
2nd: PC with PEEF and cardiac tamponade2nd episode: day 3 after high-dose Ara-C (1 g/M2 every 12 hours for 6 days) (consolidation)2nd: PericardiocentesisImmediately improved after pericardiocentesis
Lee et al.201125-year-old woman with AML-M4Recurrent PC1st episode: day 6 after the sixth dose of high-dose Ara-C (second cycle of induction remission)1st: high-dose ibuprofen (1,200 mg/day)Responded well
2nd episode: day 2 after the sixth dose of high-dose Ara-C (first consolidation)2nd: high-dose ibuprofen (1,200 mg/day) + colchicine (0.6 mg/day)Responded well within 10 days
This study201738-year-old woman with AML-M4PC/PEEFDay 3 after the fourth dose of high-dose Ara-C (first consolidation)Dexamethasone 10 mg intravenously once dailyComplete recovery within 3 days