Successful use of anakinra for colchicine-intolerant, corticosteroid-dependent recurrent pericarditis secondary to postcardiac injury syndrome after pacemaker placement

A 54-year-old woman was referred to our centre for the third recurrence of colchicine-intolerant, corticosteroid dependent iatrogenic post-traumatic pericarditis after pacemaker placement 3 months prior to the first episode. The initial episode and each recurrence were associated with a pericardial...

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Bibliographic Details
Published inBMJ case reports Vol. 12; no. 4; p. e229117
Main Authors Saad Shaukat, Muhammad Hamza, Shabbir, Muhammad Asim, Mookherjee, Sulagna, Peredo-Wende, Ruben
Format Journal Article
LanguageEnglish
Published England BMJ Publishing Group LTD 01.04.2019
BMJ Publishing Group
SeriesCase Report
Subjects
Adrenal Cortex Hormones - therapeutic use
Antirheumatic Agents - administration & dosage
Cardiac Surgical Procedures - adverse effects
Cardiovascular disease
Case reports
Colchicine - adverse effects
Female
Humans
Iatrogenic Disease
Infections
Interleukin 1 Receptor Antagonist Protein - administration & dosage
Middle Aged
Novel Treatment (New Drug/Intervention; Established Drug/Procedure in New Situation)
Pacemaker, Artificial - adverse effects
Patients
Pericarditis
Pericarditis - drug therapy
Pericarditis - etiology
Recurrence
Transplants & implants
Pericardial Disease
Pacing And Electrophysiology
Therapeutic Indications
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Summary:A 54-year-old woman was referred to our centre for the third recurrence of colchicine-intolerant, corticosteroid dependent iatrogenic post-traumatic pericarditis after pacemaker placement 3 months prior to the first episode. The initial episode and each recurrence were associated with a pericardial effusion requiring drainage. Evaluation for pericardial infection, malignancy, autoimmune disease and pacemaker lead perforation was negative. After fourth recurrence and fifth pericardial drainage in 3 months, a trial of anakinra (interleukin-1 inhibitor), in addition to swift symptom resolution successfully prevented subsequent symptomatic and echocardiographic recurrence. Corticosteroids were tapered and eventually discontinued. At 4-month follow-up, the patient continues to be on daily anakinra 100 mg subcutaneous (SQ) daily without adverse effects.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2018-229117