Ojo Noelle J, Loccoh Eméfah C, Pabon Maria A, Cuddy Sarah, Weber Brittany N
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: https://twitter.com/noelleojo.
Cardiology Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: https://twitter.com/emefahloccoh.
JACC Case Rep. 2025 Jun 25;30(16):104160. doi: 10.1016/j.jaccas.2025.104160.
Recurrent pericarditis affects up to 30% of patients after an initial episode, with the majority of recurring episodes occurring within 18 months. Younger age, subacute presentations, and initial treatment with steroids rather than colchicine are risk factors. Incorporation of multimodality imaging is essential in the diagnosis and management of recurrent pericarditis, particularly in complex cases.
A 32-year-old man was diagnosed with T-cell acute lymphoblastic leukemia (T-ALL) and recurrent acute pericarditis complicated by constriction. Management included multimodality imaging, colchicine, nonsteroidal anti-inflammatory drugs (NSAIDs), strategic dosing of steroids, and weaning based on chemotherapy and clinical response. Cardiac magnetic resonance (CMR) guided treatment adjustments, demonstrating constrictive physiology and status of inflammation.
This case highlights the role of multimodality imaging in the diagnosis and management of recurrent pericarditis in the setting of acute leukemia, enabling detailed assessment of inflammation and guiding treatment. Emerging therapies, such as interleukin (IL)-1 blockers, offer promising options for refractory cases, although their role in malignancy requires further study.
复发性心包炎在初次发作后影响多达30%的患者，大多数复发事件发生在18个月内。年轻、亚急性表现以及初始使用类固醇而非秋水仙碱治疗是危险因素。多模态成像在复发性心包炎的诊断和管理中至关重要，尤其是在复杂病例中。
一名32岁男性被诊断为T细胞急性淋巴细胞白血病（T-ALL）并伴有复发性急性心包炎并发缩窄。治疗包括多模态成像、秋水仙碱、非甾体抗炎药（NSAIDs）、类固醇的策略性给药以及根据化疗和临床反应进行撤药。心脏磁共振（CMR）指导治疗调整，显示缩窄性生理状态和炎症状况。
本病例强调了多模态成像在急性白血病背景下复发性心包炎的诊断和管理中的作用，能够详细评估炎症并指导治疗。新兴疗法，如白细胞介素（IL）-1阻滞剂，为难治性病例提供了有前景的选择，尽管它们在恶性肿瘤中的作用需要进一步研究。
