Colchicine and pericarditis

Q: Colchicine is found to be effective in pericarditis caused by? - select one

A) systemic inflammatory diseases

B) bacterial pericarditis

C) malignancy-related pericarditis

Answer: A

Colchicine is widely used for pericarditis, but it should be reserved for specific situations. Its use may be particularly harmful in bacterial pericarditis, where it may impair the clearance of the infectious organism. Similarly, it has no role in malignancy-related pericarditis and/or pericardial effusion. Also, it is not recommended in patients with recurrent pericarditis.

Said above, colchicine is an effective treatment in acute idiopathic, viral, and pericarditis caused by systemic inflammatory diseases and post-cardiac injury & surgery patients. If used, it is recommended to continue for 12 weeks after an initial episode, though many patients may develop diarrhea, nausea, and vomiting. In such cases, the dose can be decreased. Rare side effects are bone marrow suppression and liver and muscle injuries. The dose should be adjusted for lower renal GFR.

#cardiology

#pharmacology

References:

1. Schulz-Menger J, Collini V, Gröschel J, et al. 2025 ESC Guidelines for the management of myocarditis and pericarditis. Eur Heart J 2025; 46:3952.

2. Alabed S, Cabello JB, Irving GJ, et al. Colchicine for pericarditis. Cochrane Database Syst Rev 2014; :CD010652.

3. Imazio M, Brucato A, Belli R, et al. Colchicine for the prevention of pericarditis: what we know and what we do not know in 2014 - systematic review and meta-analysis. J Cardiovasc Med (Hagerstown) 2014; 15:840.

Transmission of human babesiosis

Q: Babesiosis is mostly transmitted by? - select one

A) blood transfusion

B) solid organ transplantation

C) transplacental

D) tick vectors

Answer: D

The objective of this question is to emphasize that babesiosis has increased considerably in the Northeast of the USA and is an emerging infectious disease of concern. 

The major cause is the rising deer population with concomitant increased tick density, due to lack of predators and insufficient culling of the herd. Another major reason is the expanding real estate in wooded areas.

Rash is the crucial differential diagnosis from Lyme disease, as rash rarely occurs in babesiosis. Both diseases may co-exist, though.

In its severe form, it can cause renal and liver insufficiency, ARDS, CHF, severe anemia, DIC, and shock. Spontaneous splenic rupture may occur from excessive erythrophagocytosis, a marker of high mortality.

#ID

References:

1. Krause PJ, Auwaerter PG, Bannuru RR, et al. Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA): 2020 Guideline on Diagnosis and Management of Babesiosis. Clin Infect Dis 2021; 72:185.

2.  Dumic I, Patel J, Hart M, et al. Splenic Rupture as the First Manifestation of Babesia Microti Infection: Report of a Case and Review of Literature. Am J Case Rep 2018; 19:335.

3. Krause PJ. Human babesiosis. Int J Parasitol. 2019 Feb;49(2):165-174. doi: 10.1016/j.ijpara.2018.11.007. Epub 2019 Jan 26. PMID: 30690090.

Angioedema Following Discontinuation of ACE Inhibitor Therapy

Q: Angioedema may occur even after Angiotensin Converting Enzyme inhibitor (ACE-I) is discontinued?

A) True

B) False

Answer: A

Although it is true that the only reliable treatment of ACE-I-induced angioedema is to discontinue it, it may take many months before it takes effect, and almost half of the patients may have a recurrent episode, particularly in the first month. Risk may get higher if the patient has any other reason to have angioedema.

#pharmacology

References:

1. Beltrami L, Zanichelli A, Zingale L, et al. Long-term follow-up of 111 patients with angiotensin-converting enzyme inhibitor-related angioedema. J Hypertens 2011; 29:2273.

2. Perman B, Narechania S, Malesker M. Geriatric Pharmacotherapy Case Series: Recurrent Angioedema Following Discontinuation of ACE Inhibitor Therapy. Sr Care Pharm. 2023 Jan 1;38(1):16-20. doi: 10.4140/TCP.n.2023.16. PMID: 36751921.