Intrapericardial Corticosteroid Therapy for Recurrent Malignant Pericardial Effusion: A Case Series

Background Malignant pericardial effusion (PE) and subsequent effusive-constrictive pericarditis (ECP) are significant clinical challenges in patients with advanced cancer. Case presentation: We report three cases of patients with metastatic breast or lung cancer who experienced recurrent, life-threatening cardiac tamponade despite multiple pericardiocenteses (PCC) and systemic anti-inflammatory treatment (AIT). In all cases, pericardial disease remained refractory to conventional management, and chronic systemic corticosteroid use led to debilitating side effects. Following complete drainage of the PE, a single high-dose bolus of 200 mg triamcinolone was administered via an intrapericardial catheter with a 12-hour clamping protocol. This intervention resulted in sustained pericardial stabilization for 8 to 47 months across all three patients. Remarkably, this cardiac stability was maintained independently of the underlying oncological status. Conclusion High-dose (200 mg) intrapericardial corticosteroid therapy is an effective and safe intervention for refractory malignant PE.