Pericardial Manifestations in Autoimmune Encounters: Some Worthy Facts for Consideration!

DEAR EDITOR, We read with great pleasure the manuscript by Ashrafi et al. published in a recent issue of the International Journal of Preventive Medicine. Their case highlights a very interesting association between celiac disease and pericardial manifestations. However, authors have not discussed the underlying mechanism for its causal association and treatment considerations for refractory cases. Pericarditis has previously been reported in celiac disease, and it may even manifest as a primary presenting feature. The likely mechanism is a disturbed humoral and cell‐mediated immunity including other autoimmune reactions. There is deposition of circulating immune complexes originating from the small intestine, which may resemble the etiology of pericarditis similar to the one encountered in serum sickness. The mechanisms are likely related to pericardial deposition of soluble antigen‐antibody complexes when there is excess of antigen. It may often be difficult to differentiate the pericardial syndromes encountered in inflammatory bowel disease than those with celiac disease as the clinical picture is often similar. However, the response to gluten free diet often makes the etiological association very Department of Cardiovascular Medicine, Hartford Hospital, University of Connecticut, School of Medicine, Hartford, CT, 1Department of Internal Medicine, Hartford Hospital, University of Connecticut, School of Medicine, Hartford, CT, 2Department of Cardiovascular Medicine, Saint Vincent Hospital, University of Massachusetts Medical School, Worcester, MA, USA Correspondence to: Dr. Lovely Chhabra, 80, Seymour Street, Hartford, CT 06102, USA. E‐mail: [email protected]