Version July 2025
| Idiopathic (presumed to be viral or immune-mediated) |
| In most case series, the majority of patients are not found to have an identifiable cause of pericardial disease. Frequently, such cases are presumed to have a viral or autoimmune etiology. |
| Infectious |
| Viral – Coxsackievirus, echovirus, adenovirus, Epstein-Barr virus, cytomegalovirus, influenza, varicella, rubella, HIV, hepatitis B, mumps, parvovirus B19, vaccina (smallpox vaccine), SARS-CoV-2 |
| Bacterial – Mycobacterium tuberculosis (most common cause in countries where tuberculosis is endemic), Staphylococcus, Streptococcus, Haemophilus, Pseudomonas, Neisseria (N. gonorrhoeae or N. meningitidis), Chlamydia (C. psittaci or C. trachomatis), Legionella, Salmonella, Borrelia burgdorferi (the cause of Lyme disease), Mycoplasma, Actinomyces, Nocardia, Tropheryma whippelii, Treponema, Rickettsia |
| Fungal – Histoplasma, Aspergillus, Blastomyces, Coccidioides, Candida, Actinomyces |
| Parasitic – Echinococcus, amebic, Toxoplasma |
| Noninfectious |
| Autoimmune and autoinflammatory |
| Systemic inflammatory diseases, especially lupus, rheumatoid arthritis, scleroderma, Sjögren syndrome, vasculitis, mixed connective disease, Myhre syndrome |
| Autoinflammatory diseases (especially familial Mediterranean fever and tumor necrosis factor associated periodic syndrome [TRAPS], IgG4-related disease) |
| Postcardiac injury syndromes (immune-mediated after cardiac trauma in predisposed individuals) |
| Other – Granulomatosis with polyangiitis, polyarteritis nodosa, sarcoidosis, inflammatory bowel disease (Crohn, ulcerative colitis), Whipple, giant cell arteritis, Behçet syndrome, rheumatic fever, vaccines |
| Neoplasm |
| Metastatic – Lung or breast cancer, Hodgkin disease, leukemia, melanoma |
| Primary – Rhabdomyosarcoma, teratoma, fibroma, lipoma, leiomyoma, angioma |
| Paraneoplastic |
| Cardiac |
| Early infarction pericarditis |
| Myocarditis |
| Dissecting aortic aneurysm |
| Trauma |
| Blunt |
| Penetrating |
| Iatrogenic – Catheter and pacemaker perforations, cardiopulmonary resuscitation, complication of thoracic surgery |
| Metabolic |
| Hypothyroidism (primarily pericardial effusion) |
| Uremia |
| Ovarian hyperstimulation syndrome |
| Radiation |
| Genetic |
| Mulibrey nanism, Erdheim-Chester disease |
| Drugs (rare) |
| Procainamide, isoniazid, or hydralazine as part of drug-induced lupus |
| Other – Cromolyn sodium, dantrolene, methysergide, anticoagulants, thrombolytics, phenytoin, penicillin, phenylbutazone, doxorubicin, vaccines (including vaccines to prevent SARS-CoV-2 infection) |
