Perna Francesco, Verecchia Elena, Pinnacchio Gaetano, Gerardino Laura, Brucato Antonio, Manna Raffaele
Cardiac Arrhythmia Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Eur Heart J Case Rep. 2022 Mar 18;6(4):ytac123. doi: 10.1093/ehjcr/ytac123. eCollection 2022 Apr.
Pericarditis, along with myocarditis, is being increasingly reported after the coronavirus disease 2019 (COVID-19) vaccine, but the best treatment strategy in this specific setting is still unclear.
We report a case of acute pericarditis after the second dose of mRNA COVID-19 vaccine with recurrence of large pericardial effusion after a previous pericardiocentesis and anti-inflammatory drugs tapering. The patient was successfully treated with the recombinant interleukin-1 receptor antagonist anakinra, with full reabsorption of the pericardial effusion and an abrupt drop of the inflammatory markers within 72 h. The patient was discharged a few days later, with a further decrease of the inflammatory markers and no residual symptoms.
Anakinra is being increasingly used in the treatment of recurrent pericarditis due to its capability to interrupt the autoinflammatory response leading to deleterious cytokine storms. On account of its high efficacy and rapid onset, it has been reported to rapidly reverse large inflammatory pericardial effusions. Pericarditis and myocarditis have been reported after the COVID-19 vaccine, but this is the first case of COVID-19 vaccine-related pericarditis and pericardial effusion successfully treated with anakinra, avoiding a second pericardiocentesis.
心包炎与心肌炎一样，在2019冠状病毒病（COVID-19）疫苗接种后报告越来越多，但在这种特定情况下的最佳治疗策略仍不明确。
我们报告一例在接种第二剂mRNA COVID-19疫苗后发生急性心包炎的病例，该患者在先前心包穿刺和抗炎药物逐渐减量后出现大量心包积液复发。该患者用重组白细胞介素-1受体拮抗剂阿那白滞素成功治疗，心包积液在72小时内完全吸收，炎症标志物急剧下降。患者几天后出院，炎症标志物进一步下降且无残留症状。
阿那白滞素因其能够中断导致有害细胞因子风暴的自身炎症反应，越来越多地用于复发性心包炎的治疗。由于其高效性和快速起效，据报道它能迅速逆转大量炎性心包积液。COVID-19疫苗接种后已报告有心包炎和心肌炎，但这是首例用阿那白滞素成功治疗的与COVID-19疫苗相关的心包炎和心包积液病例，避免了二次心包穿刺。
