Key result
Anakinra resolves constrictive physiology and inflammation in steroid-dependent relapsing pericarditis.
Why the study?
Constrictive pericarditis is an uncommon complication of idiopathic pericarditis historically thought to be irreversible, but transient constriction has recently been recognized during active inflammation.
Case Report (n=1)
No
Interleukin-1 receptor antagonists (anakinra) may represent a potential medical treatment for transient constrictive pericarditis driven by active inflammation, potentially avoiding the need for pericardiectomy.
Anakinra may resolve inflammatory constriction in steroid-dependent pericarditis; leaves open whether it avoids pericardiectomy in broader populations.
Background: Constrictive pericarditis is an uncommon complication of idiopathic pericarditis long thought to be irreversible, often requiring pericardiectomy to ensure recovery. Recently, transient constriction has been described in the setting of long-standing pericarditis with active inflammation. Case summary: We report the case of a 16-year-old male with an idiopathic relapsing-remitting pericarditis, refractory to non-steroidal anti-inflammatory drugs (NSAIDs), who developed constrictive physiology. Despite proper tapering, the patient developed five relapses during steroid treatment, which led to IL-1 receptor antagonist starting. After a long treatment with anakinra, constrictive physiology resolved. Disappointingly, discontinuation of interleukin-1 receptor (IL-1R) treatment was followed by a relapse of pericarditis, in the absence of signs of constriction. Discussion: Our case sustains that constrictive physiology may be a transient phenomenon, when the inflammation is still active and fibrotic transition has not been completed. When NSAIDs and steroid prove to be ineffective, IL-1R antagonist may represent a potential treatment for constrictive pericarditis, although there remains little evidence on de-escalation of IL-1R antagonist treatment in pericarditis.
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Cattaneo et al. (2025) conducted a case report in idiopathic relapsing-remitting steroid-dependent pericarditis with transient constriction (n=1). Anakinra was evaluated on Resolution of constrictive physiology and pericardial inflammation. Treatment with the interleukin-1 receptor antagonist anakinra achieved complete remission of constrictive physiology and inflammation in a patient with steroid-dependent relapsing-remitting pericarditis.
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