P401 A CASE OF CORTICO–DEPENDENT AND COLCHICINE–RESISTANT RECURRENT IDIOPATHIC PERICARDITIS: THE ROLE OF ANAKINRA

Abstract

Abstract 68–year–old female. Arterial hypertension. Diabetes. Hyperthyroidism. History of Polyserositis: 2019 massive right pleural effusion subjected to 2 thoracentesis a few days apart. Also finding of ascitic effusion. Negative etiological investigations On 3/2022 Admission to Cardiology for dyspnea and finding of pericardial effusion. CRP 10.55. On CT chest and abdomen significant pericardial effusion, mild bilateral pleural and peritoneal effusion with liver congestion. Pericardiocentesis was performed due to the absence of improvement in the pericardial effusion and persistence of sinus tachycardia despite therapy (ASA 750 mg x 3 + colchicine). Procedure complicated by Tako Tsubo syndrome. Intra–hospitalization recurrence of pericardial effusion despite NSAID therapy. Prednisone 25 mg per day was associated to therapy on board with improvement of pericardial effusion (maximum of 8 mm). At discharge WBC: 10.8, CRP: 2 (NV < 0.5 mg/dl) 04/26/22 CRP 0.73. Pericardial effusion Resolution. Cortisone tapering continued. 5/24/2022 Dyspnea and tachycardia with recurrence of significant pericardial effusion. Diagnosis of recurrent cortico–dependent and colchicine–resistant idiopathic pericarditis. New Hospitalization. Reverted to prednisone 25 mg (previous effective dose) with no effusion reduction. Anakinra introduction. At discharge: WBC 9500, CRP 0.6. Echo: maximum pericardial effusion of 20 mm. 6/10 Boosted for 3 days prednisone (50 mg/day), reduced ASA to 250 mg x 3 6/17 WBC 11.2; PCR 0.63. echo: pericardial effusion persistence max about 2.5 cm. No signs of cardiac tamponade. Boosting prednisone for a few days is ineffective. 6/24 stop ASA 6/20 stable. Start corticosteroid tapering. 7/20 asymptomatic, stable effusion. CRP 0.87. taperig prednisone again, stop colchicine. 8/18/22 Eco: slight effusion reduction. Stable CRP. Slight weight gain and slight increase in blood pressure probably caused by cortisone intake. –> prednisone reduction. 9/18 stop prednisone 10/18/2022 WBC 8.12 CRP 0.23; +2kg since last visit in August. Perimalleolar succulence. Eco: Stable effusion 2cm max. furosemide 25 mg 1 cp is added in the morning. 06/12/2022 WBC 7.5; CRP 0.52 Eco: stable effusion. Anakinra is reduced to 6 administrations per week. Conclusions Anakinra proved to be valid in stabilizing the pericardial effusion allowing to suspend corticosteroids, colchicine and ASA.