Age: 40.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Ultrasound biliary tract, Urine osmolarity, pH urine
Clinical narrative: March 2022, approximately 3 months after I received the vaccination, I had pain in the back right side of my neck which radiated down my right arm, across my chest, then down my torso. With this was some pain with breathing, mainly deep breaths. After approximately 3-4 days of it getting worse.  I consulted an urgent clinic thinking I had done something to irritate my neck muscles.  They were not able to perform MRIs and referred me to my primary provider.  I did not follow up with his as the symptoms began to get better after this consult.  Approximately 3 months later (June 23, 2022) I had the same pains but much more severe and longer lasting, approximately 7-10 days.  It began again in my neck and radiated down my right arm across my chest and down my right torso.  The pain with breathing was more prevalent with deep breaths. I consulted a family medicine doctor as my primary care provider was unavailable.  Ove the course of about a week multiple tests were completed including Chest CT, Thyroid function, Metabolic Panel, CBC, Chest x-ray, and ultrasound of gallbladder and Biliary Ducts.  These tests brought no real answers.  With discussion it was determined to be a Heartburn or GERD flare up. November 13th, approximately 5 months later It began again.  Same symptoms back of right neck, down right arm, across chest and down torso.  Pain was progressively getting worse. It did not always require a deep breath any longer. At times shallow breaths set off the pain quite severely as well.  I began taking Omeprazole to try to help with possible GERD or Heartburn flare.  After about 3 days of symptoms, on November 17th I went to the Emergency department since primary care was unable to find anything in June and emergency department can run test in a timelier manner. After  I was admitted overnight to family medicine and again multiple tests were performed, including ECG, hCG, Troponin T baseline 5th gen, CBC, Basic Metabolic, Chest Xray, COVID test, D-Dimer, Troponin T 2h/6h 5th Gen,  CT Chest, Microscopic manual, Dipstick Urine, Osmolality Urine, Ph Urine, Bacterial Culture Aerobic + Susceptibility Urine, Urinalysis with Microscopic, Dipstick POCUT Urine, Hepatic Function panel, Lipase, Sedimentation rate, CRP, Lactic Acid, Bacteria/Candida Culture blood.  I was released to go home with the DX of pericarditis of unknown etiology as well as tachycardia. I was directed to take:  Colchicine: 0.5 or 0.6 mg once daily for 3 to 6 months and ibuprofen 400 mg q6h for 1 to 2 weeks followed by a taper over 4 to 6 weeks. Patient to discuss with PCP re: taper plan. Protonix 40 mg for gastroprotection  On November 18th I was out of the hospital for approximately 5 hours.  I took a nap for about 3 hours and woke up with severe chest pains worse than any before. I went back to the emergency room. They admitted me again, this time to Cardiology. They ran multiple tests, many of the same they had earlier to get updated reports. I was again treated for DX of pericarditis of unknown etiology.  After 3 days in the Hospital, I was released November 22nd.  I had intermittent pains in the next few days while on Colchicine: 0.6 mg once daily for 3 to 6 months and beginning an aspirin tapper of 650 mg 4 times a day for 2 weeks.   2 days later November 24th the chest pains became quite severe again throughout the night. I got little to no sleep.   By morning the pains had subsided enough to be somewhat tolerable.  That night November 25th, the pains increased again, and early the next morning I went back to the emergency room.  This time they did an ECHO and determined the little fluid I had on my heart was causing more issues than they realized. I drained the fluid from my heart (pericardiocentesis), 200cc drained.  I was monitored in the hospital until November 29th.   I was released with DX of Pericardial effusion and Pericarditis. Prescribed: Continue colchicine 0.6 mg BID for 3 months.  Continue high-dose aspirin 650 mg 4 times daily for 1 month and then tapering down weekly. Protonix to coat my stomach and protect from amount of aspirin I was taking.  I was also directed to follow-up with primary care provider this week with CBC and BMP and follow up in Pericardial Disease Clinic 12/8/2022. Consider repeat echocardiogram at that time.  I followed up with my primary care provider on 12/2 and with Cardiology on 12/8. Tests were run to review updated results.  With Cardiology I discussed the plan of care, aspirin taper every 2 weeks, once daily Colchicine 3-6 months.  If I feel I am developing recurrent symptoms reach out to clinic to obtain inflammatory markers, otherwise there would be no follow up visits with cardiology.   My CBC was checking 12/15 & 1/5.  CRP was also tested on 12/15.   January 7th, I returned to the Emergency room with chest pains. Test were completed, EKG, Bloods, Chest Xray, Echo, Metabolic panel. I Was released with recommendation to increase aspirin taper 650MG t.i.d. Also, follow up with pericardial clinic.  I then presented to the Emergency room again January 9th with increased chest pain. Test completed Chest Xray, Metabolic panel, CRP, NT-Pro BNP, CBC, hCG Troponin T Baseline Troponin T 2H/6H 5th Gen ECG 12 lead.   I was admitted to Cardiology due to elevated CRP, ESR and pulse rates.   My Aspirin was replaced by Indomethacin, I continued my regimen of Colchicine .6 mg b.i.d. I was also placed on a 5-day course of 30mg of prednisone while in hospital.  I was discharged 1/16 with prescriptions:  Indomethacin (replacing aspirin), Colchicine, Protonix.  January 31st, I returned to the Emergency room with stiff neck and chest pains when breathing which had progressively gotten worse since Jan 28th.  After multiple test and review by Cardiology team I was admitted with significant recurrent Pericarditis or Uncertain Etiology.  The plan was treatment with possible long Steroid taper or IL-1 Inhibitor.   Dr (expert in Pericarditis) was consulted for a possible IL-1 inhibitor. In this discussion it was learned I may qualify for a clinical trial focused on treating recurrent pericarditis using an oral drug Inhibitor, called CardiolRX.  When presented with the options, IL-1 inhibitor, clinical trial drug or steroid taper, I chose the clinical trial drug.  I started the trial on Feb 2, 2023, receiving 1 dose.  While on the trail drug I continued Indomethacin, Colchicine and pain control medication.  I was monitored in the hospital until Feb 6, 2023. At this time, I was discharged to home.  I was to maintain Indomethacin does 3 times a day 75 mg/50mg/75 mg, and Colchicine .6 twice a day along with the trial drug CardiolRx 495 mg twice a day.  As I progressed through the drug study the dosage changed according to trial rules, regulations, and plan, with this ending August 3rd, 2023.  From my discharge February 6, 2023, I have continued to have pain intermittently.  Sometimes the pain was stronger and worse than others.  Dr has continued to monitor my progress through this process.  Per drug study guideline my Indomethacin was removed from my prescriptions in early to mid-April.  In May my Colchicine prescription was removed as well.  On May 23rd I began to have pain in my neck again.  May 24th, I met with Dr for a routine visit regarding my drug study.  By the next day my pain had gotten worse and moved down to my chest.  Dr reinstated my Colchicine prescription and started me on Ibuprofen 800mg 3 times a day. This continued with bi-weekly monitoring of CRP CBC and Creatinine with Estimated GFR until the drug study was complete.  Since the study has completed Dr has tested my CRP and Basic Metabolic Panel monthly due to my CRP levels being high.  He feels he will continue my dose of Colchicine at least until August 2024.  I am also currently still taking 200 mg of aspirin 3 times a day, and this has been tapered down from 800mg 3 times a day since discontinuing the study drug August 3rd.