SHM Converge Scientific Abstract ePoster Gallery-Idiopathic Recurrent Pericarditis-Challenges in Treatment

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This case describes a 36-year-old man with recurrent idiopathic pericarditis. He presented with fever, sharp substernal chest pain worsened by lying down and inspiration, exertional dyspnea, and fatigue. He reported two similar prior episodes that improved with ibuprofen. On evaluation, he was febrile and mildly tachycardic, but physical exam was otherwise unremarkable. Echocardiogram and CTA chest showed a moderate pericardial effusion, with small bilateral pleural effusions also noted.<br /><br />Laboratory workup showed markedly elevated inflammatory markers (ESR 69 mm/hr, CRP 179 mg/L), while CBC, metabolic panel, and liver tests were normal. Extensive infectious evaluation was negative, including hepatitis, Lyme, tuberculosis, syphilis, COVID-19, and blood cultures. Autoimmune testing was largely negative except for a borderline ANA titer of 1:80 with a speckled pattern.<br /><br />He was treated initially with colchicine and high-dose ibuprofen, along with exercise restriction, and his inflammatory markers normalized within 10 days. However, symptoms returned within a week after colchicine was stopped, supporting the diagnosis of idiopathic recurrent pericarditis. Because of recurrence despite standard therapy, anakinra, an IL-1 inhibitor, was planned. The patient remains symptom-free on colchicine while awaiting insurance approval for anakinra.<br /><br />The report highlights that idiopathic recurrent pericarditis is often difficult to manage due to frequent relapses and dependence on NSAIDs, colchicine, or corticosteroids. It also emphasizes the inflammatory, autoinflammatory nature of the disease and the potential role of IL-1 blockade, such as anakinra, when conventional treatment fails.

Asset Subtitle

Tissa Bijoy George

Meta Tag

Author List Aleesha Kainat, Anjana Chandrasekhara Pillai, Khushboo Singh, Tissa Bijoy George

Category Clinical Vignettes

Concept Idiopathic Recurrent Pericarditis

Concept Chest Pain

Concept NSAID

Concept Colchicine

Concept Inflammatory Markers

Distinguished Non-Finalist

Presenter Organization Upmc

Presenting Author Tissa Bijoy George

Track Adult

Keywords

recurrent pericarditis

idiopathic pericarditis

pericardial effusion

colchicine

ibuprofen

anakinra

IL-1 inhibitor

inflammatory markers

chest pain

autoinflammatory disease

Idiopathic Recurrent Pericarditis

Chest Pain

NSAID

Colchicine

Inflammatory Markers