Acute chest pain in an elite rugby player: A case report of polyserositis with cardiac involvement

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ID: 333714
2026
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Abstract
Abstract Background The evaluation of chest pain is a common reason for athletes to seek consultation at a sports medicine clinic. Musculoskeletal causes are by far most frequent; however, rare and potentially life-threatening etiologies must also be considered. Case summary A 22-year-old professional rugby player presented with pleuritic chest pain of two week’s duration. Physical examination was unremarkable except for reduced breath sounds at the left lung base. Laboratory testing demonstrated marked systemic inflammation with a C-reactive protein level of 237mg/l and mildly elevated high-sensitivity troponin T (21pg/mL). Transthoracic ultrasound identified a fibrinous left-sided pleural effusion and a mild circumferential pericardial effusion. Subsequent cardiac magnetic resonance imaging (CMRI) confirmed the diagnosis of acute pericarditis. Comprehensive rheumatological evaluation established an autoimmune etiology, consistent with a polyserositis secondary to mixed connective tissue disease (ANA 1:80.000, speckled pattern, anti-RNP positive). Anti-inflammatory therapy with ibuprofen, colchicine and a corticosteroid pulse were initiated, resulting in clinical improvement and gradual normalization of laboratory and sonographic imaging findings within 6 weeks. After three months of sports restriction, follow-up CMRI demonstrated significant pericardial late gadolinium enhancement but without evidence of active inflammation. A gradual return-to-exercise protocol was subsequently implemented. Anti-inflammatory medication was discontinued after six months. The athlete has since remained clinically stable under regular follow-up for one year. Discussion This case highlights the importance of thorough diagnostic evaluation of chest pain in young athletes, including consideration of autoimmune causes like polyserositis. Despite structured follow-up, uncertainty persists regarding recurrence risk and its significance for long-term athletic participation.
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Authors Theresa Betz, Norbert Blank, Maura Magdalena Zylla, Birgit Friedmann‐Bette
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Journal European Heart Journal - Case Reports
Year 2026
DOI
10.1093/ehjcr/ytag784
URL
https://academic.oup.com/ehjcr/advance-article-pdf/doi/10.1093/ehjcr/ytag784/72380773/ytag784.pdf
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