Pericarditis in COVID-19: a focus on the paediatric population

Q: What is the clinical evidence from this study?

Study design: Review. Population: Pediatric SARS-CoV-2-associated pericarditis. Intervention: SARS-CoV-2 infection. Primary outcome: Clinical presentation, diagnosis, management, and outcomes of pediatric SARS-CoV-2-associated pericarditis.

Q: What does this research mean for the field?

Pediatric SARS-CoV-2-associated pericarditis is primarily driven by an immune-mediated hyperinflammatory response rather than direct viral invasion, responds well to conventional anti-inflammatory treatments, and generally carries a favorable prognosis. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Celina R. Bou Jaoude; Fayez Yassine; Bshara Sleem; Ali Awada; Fadi Fouad Bitar; Mariam Toufic Arabi

doi:10.1017/s1047951126124688

November 13, 2026Cardiology in the YoungOpen Access

Pericarditis in COVID-19: a focus on the paediatric population

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Key result

Pediatric SARS-CoV-2-associated pericarditis carries a favorable prognosis with NSAIDs and colchicine despite rare tamponade.

Why the study?

Pediatric SARS-CoV-2-associated pericarditis is uncommon and likely underreported, necessitating a summary of its epidemiology, pathophysiology, clinical presentation, diagnosis, management, and outcomes in children.

Key Points

To summarize the epidemiology, pathophysiology, clinical presentation, diagnosis, management, and clinical outcomes of SARS-CoV-2-associated pericarditis in children.
Narrative review of published literature on pediatric SARS-CoV-2-associated pericarditis, including acute pericarditis, myopericarditis, pericardial effusion, cardiac tamponade, and multisystem inflammatory syndrome in children (MIS-C).
Per CDC surveillance reports, the incidence of myocarditis or combined myocarditis/pericarditis was 12.6–17.6 cases per 100,000 in males aged 5–11 years, 50.1–64.9 cases per 100,000 in males aged 12–17 years, and 5.4–10.8 cases per 100,000 in females aged 5–11 years.
Pathophysiology is predominantly immune-mediated via systemic hyperinflammation and cytokine release (interleukin-1, interleukin-6, interleukin-8, and TNF-α) rather than direct viral invasion of the pericardium.
First-line management relies on nonsteroidal anti-inflammatory drugs and colchicine; while most pediatric patients experience favorable recovery, severe pericardial effusion, cardiac tamponade, and recurrences can occur.

Structured PICO

P

Population

Pediatric patients ranging from neonates to adolescents with SARS-CoV-2-associated pericarditis, pericardial effusion, cardiac tamponade, myopericarditis, or multisystem inflammatory syndrome in children (MIS-C).

E

Exposure

Management therapies including nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen, aspirin) and colchicine as first-line therapies; corticosteroids (prednisolone, dexamethasone, methylprednisolone), intravenous immunoglobulin (IVIG), and interleukin-1 blockade (anakinra) in selected inflammatory, MIS-C-associated, or refractory/recurrent cases; and pericardiocentesis or surgical pericardial drainage/pericardiectomy for severe effusion or tamponade.

O

Outcome

Clinical recovery, recurrence of pericarditis or effusion, and complications such as severe pericardial effusion or cardiac tamponade.

This narrative review synthesizes the clinical spectrum, immune-mediated pathophysiology, multimodal diagnostic approach, and extrapolated management strategies for pediatric SARS-CoV-2-associated pericarditis, emphasizing the critical need to differentiate isolated disease from myocarditis and MIS-C.

Limitations

Data in the pediatric population remain limited and dominated by case reports and small series
Management and therapeutic strategies are largely extrapolated from established pediatric pericarditis principles and adult data
True incidence of isolated pericarditis is unclear because estimates often combine myocarditis and pericarditis or overlap with MIS-C
Data on SARS-CoV-2-associated pericarditis in the pediatric population remain limited and the true incidence is unclear.
Epidemiological estimates often combine myocarditis and pericarditis, making it challenging to determine the exact incidence of isolated pericarditis.
Management is largely extrapolated from established pediatric pericarditis principles and adult data.
Reported pediatric cases often include overlap with MIS-C, myocardial involvement, or systemic inflammatory features rather than isolated acute pericarditis.

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Implication

May support NSAID-colchicine as initial therapy in pediatric SARS-CoV-2 pericarditis; leaves open prospective confirmation of immune-mediated mechanism and recurrence risks.

Abstract

BACKGROUND: COVID-19, caused by SARS-CoV-2, is primarily a respiratory illness but may cause cardiovascular complications, including pericarditis. Pediatric SARS-CoV-2-associated pericarditis remains uncommon and likely underreported. This review summarizes the epidemiology, pathophysiology, clinical presentation, diagnosis, management, and outcomes of pericarditis associated with SARS-CoV-2 infection in children. METHODS: We narratively reviewed the available literature on SARS-CoV-2-associated pericarditis in the pediatric population, including isolated acute pericarditis, myopericarditis, pericardial effusion, cardiac tamponade, and pericardial involvement in multisystem inflammatory syndrome in children (MIS-C). RESULTS: The true incidence of pediatric SARS-CoV-2-associated pericarditis remains unclear. Reported cases suggest that older children and adolescents are more commonly affected, typically presenting with chest pain, fever, dyspnea, or tachycardia, whereas younger children may exhibit nonspecific symptoms. Diagnosis relies on clinical criteria supported by electrocardiography, echocardiography, inflammatory markers, and cardiac biomarkers, with cardiac magnetic resonance imaging useful when myocardial involvement is suspected. Available evidence suggests a predominantly immune-mediated pathophysiology involving cytokine dysregulation and systemic inflammation, with limited evidence of direct viral invasion. Management is largely extrapolated from established pediatric pericarditis principles and adult data. Nonsteroidal anti-inflammatory drugs and colchicine are first-line therapies, while corticosteroids or intravenous immunoglobulin may be considered in selected inflammatory or MIS-C-associated cases, and interleukin-1 blockade in refractory or recurrent disease. Most affected children recover, although severe pericardial effusion, tamponade, and recurrence have been reported. CONCLUSION: Pediatric SARS-CoV-2-associated pericarditis encompasses a spectrum of clinical presentations and generally carries a favorable prognosis. Nevertheless, potentially serious complications emphasize the importance of early recognition, differentiation from myocarditis and MIS-C, and structured follow-up.

Discussion

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Cite This Study

Jaoude et al. (2026) conducted a review in Pediatric SARS-CoV-2-associated pericarditis. SARS-CoV-2 infection was evaluated on Clinical presentation, diagnosis, management, and outcomes of pediatric SARS-CoV-2-associated pericarditis. Pediatric SARS-CoV-2-associated pericarditis is predominantly immune-mediated and generally carries a favorable prognosis with NSAIDs and colchicine, though tamponade and recurrence can occur.

synapsesocial.com/papers/6af88c530e4d8f4b089c1c1f https://doi.org/10.1017/s1047951126124688

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Pericarditis in COVID-19: a focus on the paediatric population

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Pericarditis in COVID-19: a focus on the paediatric population

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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