Abstract

Recurrent pericarditis (RP) is a clinical syndrome characterized by recurrent attacks of acute pericardial inflammation. Prognosis quoad vitam is good, although morbidity might be significant, especially in children and adolescents. Multiple potential etiologies result in RP, in the vast majority of cases through autoimmune or autoinflammatory mechanisms. Idiopathic RP is one of the most frequent diagnoses, that requires the exclusion of all known etiologies. Therapeutic advances in the last decade have been significant with the recognition of the effectiveness of anti IL1 therapy, but a correct diagnostic and therapeutic algorithm is of key importance. Unfortunately, most of evidence comes from studies in adult patients. Here we review the etiopathogenesis, diagnosis and management of RP in pediatric patients.

Highlights

  • Reviewed by: George Lazaros, Hippokration General Hospital, Greece Dingding Xiong, St

  • After the attack has subsided, acute pericarditis may recur leading to recurrent pericarditis (RP) in about 15–30% of adult patients [4, 5] and in 35% of pediatric patients [6]

  • Not being part of the typical disease features, pericarditis has been described in the setting of multiple autoinflammatory conditions, including Hyperimmunoglobulinemia D with periodic fever syndrome (HIDS) [60], NOD2-associated autoinflammatory syndrome [61], and chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature (CANDLE) [62]

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Summary

Recurrent Pericarditis in Children and Adolescents

Reviewed by: George Lazaros, Hippokration General Hospital, Greece Dingding Xiong, St. Recurrent pericarditis (RP) is a clinical syndrome characterized by recurrent attacks of acute pericardial inflammation. Most of evidence comes from studies in adult patients. We review the etiopathogenesis, diagnosis and management of RP in pediatric patients. Acute pericarditis accounts for 5% of the presentations to the emergency department for chest pain in pediatric patients [3]. After the attack has subsided, acute pericarditis may recur leading to recurrent pericarditis (RP) in about 15–30% of adult patients [4, 5] and in 35% of pediatric patients [6]. RP in children and adolescents is frequent, and has important specificities that will be review here

Clinical and Etiological Classification
Acute Pericarditis Recurrent pericarditis
Autoinflammatory Other genetic conditions Iatrogenic
Malignancies Uremia Mixedema Anorexia nervosa
Secondary RP
Major Minor
RP Secondary to Other Pediatric Disorders
Diagnostic Specificities in the Pediatric Age
PROGNOSIS OF RECURRENT PERICARDITIS IN THE PEDIATRIC AGE
ROLE OF IMAGING
Prednisone IVIG
MANAGEMENT OF RECURRENT PERICARDITIS IN THE PEDIATRIC AGE
Management of Acute Attacks
Daily dose*
Prevention of Recurrences and Other Complications
Interventional Therapy for Relapsing Pericarditis
Lifestyle Recommendations
Findings
CONCLUSIONS

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