Beyond the Flare: Recurrent pericarditis in children and adolescents: report of 16 cases

Abstract Objectives In this study, we aimed to evaluate the clinical findings and follow-up data of 16 children and adolescents with recurrent pericarditis (RP). Methods This study had a retrospective design and included 16 pediatric patients (14 males, 2 females) with recurrent pericarditis evaluated between January 2017 to January 2023. The initial diagnosis of pericarditis was made according to the criteria determined in the European Society of Cardiology guideline. Results We enrolled 16 children with recurrent pericarditis with median age 12.8 years (8–17 years). Pericardial effusion in 11 patients (68.7%). Eight patients (50%) presented with fever. Pericardiocentesis was performed in 9 (56.2%) patients. The median erythrocyte sedimentation rate (ESR); C-reactive protein (CRP) levels at the time of diagnosis (IQR) were 43 (25–70) mm/h and 107 (61–190) mg/L, respectively. In total, 16 patients had 36 recurrences (mean 2.25, range 2–6) during follow-up. The main symptom during the relapses was chest pain, similar to that of the first attack. Four patients (25%) had a history of previous cardiac surgery. Three patients were treated with nonsteroidal anti-inflammatory drugs (NSAIDs) only. NSAID and colchicine were administered to 13 patients. One patient received corticosteroid and one patient received anakinra treatment. Conclusions Patients with recurrent pericarditis in childhood have an autoinflammatory phenotype. Furthermore, successful management of patients with recurrent pericarditis requires a teamwork approach involving cardiologists, rheumatologists and clinical immunologists.