Letter to the editor J Cardiovasc Med 2017, 18:731 Refractory idiopathic recurrent pericarditis: treatment with interleukin-1 receptor antagonist is an option! Kubra Ozturk a , Murat Deveci b and Zelal Ekinci c a Kocaeli University, Department of Pediatric Rheumatology, b Kocaeli University, Department of Pediatric Cardiology and c Kocaeli Academy for Solidarity Correspondence to Kubra Ozturk, Kocaeli University Hospital, Department of Pediatric Rheumatology, 41380 Umuttepe Kocaeli, Turkey Tel: +90 262 303 7500; fax: +90 262 3037003; e-mail: ozturk1209@gmail.com Received 11 January 2017 Revised 28 February 2017 Accepted 3 March 2017 To the Editor We read with a great interest the systemic review about the treatment of idiopathic recurrent pericarditis (IRP) with anakinra. 1 We would like to share our experience with anakinra in an adolescent with IRP under current discussions of the treatment options. A 17-year-old boy was admitted to Pediatric Cardiology Department with complaints of chest pain and dyspnea. His medical history was unremarkable, except for the past 18 months, during which he had eight similar epi- sodes of chest pain that were responsive to NSAIDs and each one lasting for 3–7 days. He was treated with colchicine for the last episode for 3 months. Physical examination showed shortness of breath, an increased heart rate (118 beats/min), and deep heart sounds. Laboratory tests showed an increase in acute-phase reac- tants. Echocardiography revealed moderate pericardial effusion. Viral serology, C3, C4, ANA, genetic studies testing for familial Mediterranean fever, and tumor necrosis factor receptor-associated periodic syndrome were negative. He responded well to an appropriate dosage of ibuprofen, colchicine, and was discharged with- out pericardial effusion. He showed a severe recurrence after 6 weeks of wellness under colchicine and required pericardiocentesis due to a large amount of effusion and prednisolone which was started immediately. Two weeks after discontinuation of prednisolone, the patient experi- enced a new episode of pericarditis with chest pain and increased C-reactive protein. He was treated with only 2 mg/kg/day anakinra subcutaneously with official per- mission, because it was on off-label use. Dramatic clinical response and normalization of the laboratory findings within 24–48 h was achieved. Anakinra was discontinued after a 3-month tapering period at the end of 9 months’ daily therapy. He experienced a recurrence 7 days after anakinra discontinuation. Anakinra was restarted and an immediate remission was held. As previously described, 2 anakinra was used in selected patients. Also a preliminary study 3 showed that the use of anakinra reduced the risk of recurrence. As a conclusion, this is a case of IRP recurring under colchicine. Remission was held solely with anakinra with- out steroids, NSAIDs, and colchicine during its first usage. Early recurrence is an expected complication of anakinra withdrawal and it should be tried with a very long tapering dosage. Our plan is to switch alternate days at the third month and then continue to tapper to find out the minimal dosage to held remission. Acknowledgements Conflicts of interest None declared. References 1 Lazaros G, Imazio M, Brucato A, et al. Anakinra: an emerging option for refractory idiopathic recurrent pericarditis: a systematic review of published evidence. J Cardiovasc Med 2016; 17:256–262. 2 Imazio M, Brucato A, Pluymaekers N, et al. Recurrent pericarditis in children and adolescents: a multicentre cohort study. J Cardiovasc Med 2016; 17: 707–712. 3 Brucato A, Imazio M, Gattorno M, et al. Effect of anakinra on recurrent pericarditis among patients with colchicine resistance and corticosteroid dependence the AIRTRIP randomized clinical trial. J Am Med Assoc 2016; 316:1906–1912. 1558-2027 ß 2017 Italian Federation of Cardiology. All rights reserved. DOI:10.2459/JCM.0000000000000520 © 2017 Italian Federation of Cardiology. All rights reserved.