Spodick’s sign in pericarditis

A 21-year-old female patient with a history of acute myeloid leukemia underwent bone marrow transplantation a year prior. She was admitted presenting with dyspnea and chest discomfort during physical exertion. Her baseline electrocardiogram (ECG) taken a year ago showed a normal sinus rhythm at 87 bpm, a standard axis and no ST-T wave anomalies (Figure 1A). (A) A baseline electrocardiogram taken a year ago. (B) An electrocardiogram upon admission. Upon admission, her ECG revealed diffuse ST-segment elevations in leads I, II, III, aVL, aVF and V4–V6 (Figure 1B). Notably, the down-sloping TP segment from a QRS complex to the subsequent PR segment, indicated by a red arrow, is termed ‘Spodick’s sign’. This sign aids in diagnosing acute pericarditis. Characteristically, Spodick’s sign presents as a downsloping TP segment, most distinctly observed in lead II and lateral precordial leads. A transthoracic echocardiogram detected a moderate pericardial effusion (Figure 2), yet there were no indications of left ventricular wall motion irregularities. Diagnostic pericardiocentesis extracted 500 ml of blood-tinged fluid, which tested negative for cytology, immunohistochemistry and microbiology. Echocardiogram revealed a moderate pericardial effusion. Spodick’s sign is predominantly evident in lead II and the lateral precordial leads. Studies suggest its presence in ∼80% of acute pericarditis cases.1,2 This sign is valuable in distinguishing acute pericarditis from acute coronary syndrome. While PR segment depression may manifest in both conditions, the existence of Spodick’s sign leans toward a diagnosis of acute pericarditis. Late pericarditis can develop in nearly 5% of survivors of allogeneic hematopoietic stem cell transplantation, predominantly impacting those with moderate to severe chronic graft-vs-host disease. Following diagnosis, the patient underwent augmented immunosuppression therapy with methylprednisolone and mycophenolate mofetil. Post pigtail drainage removal, no subsequent accumulation of pericardial effusion was noted. Z.W. and Y.-T.Z. contributed to conception and literature search. Y.-T.Z. and F.X. contributed draft of the manuscript and revision. Z.W. contributed to design and approved the manuscript be submitted. This manuscript is not under consideration elsewhere. Furthermore, none of the contents of the manuscript have been previously published. In addition, all of authors have read and approve the manuscript. Written consent has been obtained from the patient for publication. None declared. All data relevant to the study are included in the article.