Key result
Rilonacept induces recurrent pericarditis remission in an athlete, but discontinuation triggers relapse despite CMR resolution.
Why the study?
Recurrent pericarditis in young athletes is challenging, as relapse risk, treatment duration, and return to play must be balanced.
Case Report (n=1)
This case demonstrates the complexity of managing recurrent pericarditis in high-risk athletes, highlighting that relapse can occur after rilonacept withdrawal despite clinical and CMR improvement.
BACKGROUND: Recurrent pericarditis in young athletes is challenging, as relapse risk, treatment duration, and return to play must be balanced. CASE SUMMARY: A 26-year-old rugby player developed recurrent pericarditis after atrial septal defect repair. At initial presentation, she had moderate pericardial late gadolinium enhancement on cardiac magnetic resonance (CMR) and a high pericarditis risk score, and she achieved clinical remission on rilonacept. At taper initiation, she was asymptomatic with normal inflammatory biomarkers yet showed mild residual late gadolinium enhancement on CMR. After tapering of rilonacept, she relapsed 11 months later but responded rapidly to reinitiation of therapy. DISCUSSION: This case highlights the challenges of recurrent pericarditis in a high-risk athlete and discusses athlete-specific considerations, including exercise restriction and individualized return to activity. It also suggests that serial CMR and clinical risk scores may provide supportive context for cautious tapering, although evidence remains limited. TAKE-HOME MESSAGES: This case demonstrates the complexity of recurrent pericarditis management in a high-risk athlete despite clinical and CMR improvement. Serial CMR and clinical risk scores may provide supportive, hypothesis-generating context for individualized care and cautious tapering.
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Abuawad et al. (2026) conducted a case report in Recurrent pericarditis (n=1). Rilonacept was evaluated on Clinical remission and relapse. In a high-risk athlete with recurrent pericarditis, rilonacept induced remission, but discontinuation after 2 years led to relapse despite clinical and CMR improvement, resolving upon reinitiation.
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