Intravenous Immunoglobulin Therapy for Refractory Recurrent Pericarditis

Abstract

Recurrent pericarditis is a troublesome complication of idiopathic acute pericarditis and occurs more frequently in pediatric patients after cardiac surgery (postpericardiotomy syndrome). Conventional treatment with nonsteroidal antiinflammatory drugs, corticosteroids, and colchicine is not always effective or may cause serious adverse effects. There is no consensus, however, on how to proceed in those patients whose disease is refractory to conventional therapy. In such cases, human intravenous immunoglobulin, immunosuppressive drugs, and biological agents have been used. In this report we describe 2 patients with refractory recurrent pericarditis after cardiac surgery who were successfully treated with 3 and 5 monthly high-dose (2 g/kg) intravenous immunoglobulin until resolution of the effusion. Our experience supports the effectiveness and safety of this therapy.

Colchicine for children with pericarditis: systematic review of clinical studies

“…Three studies (two case reports and one case series) were in children with postpericardiotomy syndrome 13 20 21…”

“…One case series13 and two case reports20 21 reported the use of colchicine in children with postpericardiotomy syndrome.…”

“…Yazigi and Abou-Charaf4 and Del Fresno et al 21 used a colchicine dose of 0.25–0.5 mg/day for 4–6 months. Colchicine 1 mg/day was used in some studies15 16 18 19 20 22 23 for 6 months.…”

“…On the other hand, one case series13 and five case reports18–22 that included 12 children showed that colchicine did not prevent recurrences. Three of these studies were in children with postpericardiotomy syndrome 13 20 21. Two studies18 19 reported children with pericarditis resistant to colchicine but responded to the use of interleukin 1b receptor antagonist (anakinra).…”

Colchicine and beyond: New options for the treatment of pericarditis

“…Of nine patients, eight had a complete clinical remission after one or two cycles. Del Fresno et al [21] reported clinical remission with IVIg in two pediatric patients with refractory post-cardiac surgery pericarditis. The rapidity and completeness of the clinical response to IVIg have been impressive, and this approach has the potential advantage that patients need not receive chronic drug treatment.…”