Resolution of Colchicine-Resistant, Corticosteroid-Dependent Acute Idiopathic Recurrent Pericarditis With Rilonacept: A Case Report

Pericarditis, the most common disease of the pericardium, is characterized by pleuritic, sharp, stabbing chest pain that worsens with breathing. Pericarditis can arise from various causes, including viral infections, malignancies, and drug reactions, though the cause often remains idiopathic. Treatment typically involves nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, and/or corticosteroids. In rare cases, biologic therapy may be required. Rilonacept, a recently approved interleukin-1 (IL-1) inhibitor for recurrent pericarditis, has shown promise in alleviating symptoms and preventing recurrence. Unlike NSAIDs, which inhibit cyclooxygenase enzymes, and colchicine, which disrupts microtubule assembly and inflammatory chemotaxis, rilonacept binds IL-1 and blocks proinflammatory signaling cascades. Additionally, while long-term corticosteroids do inhibit proinflammatory cytokines, they are known to have a host of long-term side effects, including osteoporosis and hyperglycemia. The efficacy of rilonacept across various stages of pericardial inflammation and in all recurrent cases remains uncertain. We report a case of idiopathic acute recurrent pericarditis in a 55-year-old South Asian woman. Eight months after the initial diagnosis, she experienced rising inflammatory markers and intermittent fevers despite treatment with ibuprofen and colchicine. Her condition progressed to corticosteroid dependence and marginal pericardial calcification, identified via an echocardiogram eight days after recurrent symptoms began. Symptom resolution and inflammation control were achieved with rilonacept, showing sustained success at a 12-month follow-up.