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Canadian Journal of Cardiology

Incessant Pericarditis Successfully Treated With Anakinra in a Patient on Active Treatment for Mediastinal Lymphoma

  • Author Footnotes
    ‡ These authors contributed equally to this work.
    Massimiliano Camilli
    Footnotes
    ‡ These authors contributed equally to this work.
    Affiliations
    Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy

    Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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  • Author Footnotes
    ‡ These authors contributed equally to this work.
    Marcello Viscovo
    Footnotes
    ‡ These authors contributed equally to this work.
    Affiliations
    Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Rome, Italy
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  • Stefan Hohaus
    Affiliations
    Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Rome, Italy

    Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
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  • Priscilla Lamendola
    Affiliations
    Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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  • Elena Verrecchia
    Affiliations
    Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Periodic Fevers Research Center, Catholic University of the Sacred Heart, Rome, Italy
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  • Laura Gerardino
    Affiliations
    Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Periodic Fevers Research Center, Catholic University of the Sacred Heart, Rome, Italy
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  • Filippo Crea
    Affiliations
    Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy

    Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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  • Antonella Lombardo
    Correspondence
    Corresponding author: Dr Antonella Lombardo, Department of Cardiovascular Medicine, Fondazione Policlinico A. Gemelli IRCCS, L.go A. Gemelli, 8 – 00168 Rome, Italy, Tel.: +39-06-30154187.
    Affiliations
    Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy

    Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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  • Raffaele Manna
    Affiliations
    Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Periodic Fevers Research Center, Catholic University of the Sacred Heart, Rome, Italy
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  • Author Footnotes
    ‡ These authors contributed equally to this work.
Published:November 02, 2022DOI:https://doi.org/10.1016/j.cjca.2022.10.027
      Hematologic malignancies are common causes of pericardial effusion (PE), which can occur as first disease manifestation and may be associated with poor prognosis.
      • Imazio M.
      • Colopi M.
      • De Ferrari G.M.
      Pericardial diseases in patients with cancer: contemporary prevalence, management, and outcomes.
      Many oncologic patients have suboptimal response to standard medical therapies; they may necessitate pericardial drainage
      • Imazio M.
      • Colopi M.
      • De Ferrari G.M.
      Pericardial diseases in patients with cancer: contemporary prevalence, management, and outcomes.
      or administration of long-term corticosteroids (CCSs), which is known to be associated with a more prolonged disease course and higher risk of recurrence.
      • Imazio M.
      • Colopi M.
      • De Ferrari G.M.
      Pericardial diseases in patients with cancer: contemporary prevalence, management, and outcomes.
      • Adler Y.
      • Charron P.
      • Imazio M.
      • et al.
      2015 ESC Guidelines for the diagnosis and management of pericardial diseases: the Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC).
      • Imazio M.
      • Lazaros G.
      • Gattorno M.
      • et al.
      Anti-interleukin-1 agents for pericarditis: a primer for cardiologists.
      We present the case of a patient affected by primary mediastinal large B-cell lymphoma (PMLBCL) and incessant pericarditis, successfully treated for the first time with interleukin (IL)-1 receptor antagonist anakinra. Case timeline and examinations performed are shown in Table 1.
      Table 1Case report timeline including microbiological, oncologic, and autoimmunity examinations
      Laboratory testing (reference ranges) Diagnosis of PMBCL

      6 cycles R-CHOP 14 and radio-therapy

      09/04/2021
      PET-TC: DS5

      MiCMA first cycle (25/11)
      15/12

      First episode of pericarditis;

      First-line therapy: colchicine 1 mg/d and indomethacin 50 mg/8h
      05/01

      After MiCMA second cycle
      10/01

      Second-line therapy: colchicine

      1 mg/d and high-dose prednisone
      02/02

      Pericardial tamponade 700 cc sero-ematic fluid drained and rechallenge with colchicine and CCS
      10/02

      Apheresis for ASCT

      13/02

      New rechallenge with CCS
      25/02

      Multidisciplinary discussion; anakinra 100 mg/d
      03/03

      After first week of anakinra
      15/03

      After second week of anakinra
      WBC count (4-10 x 10ˆ9/L) 810 1200 800 1500 6500 1850 1560 1420
      CRP values (< 5 mg/L) 135 160 200 150 185 180 80 13.5
      Hs troponin (< 5 ng/L) 13 10 16 12 14 NA 5 NA
      NT-proBNP (< 227 pg/mL) 135 124 150 123 NA NA NA NA
      ANA Below detectable limit
      ENA Below detectable limit
      Ds-DNA antibody Below detectable limit
       p-ANCA antibody Below detectable limit
       c-ANCA antibody Below detectable limit
      Infective serology (including HBV/HCV, HIV, IFN-gamma dosage for detection of mycobacterium) Negative Negative
      Microbiological tests on pericardial fluid Negative
      Symptoms (chest pain) Absent Present Present Present Momentarily absent Present Present Absent Absent
      ANA, antinuclear antibody; ANCA, antineutrophil cytoplasmic antibody; ASCT, autologous steam cell transplantation; CCS, corticosteroid; CRP, C-reactive protein; DNA, deoxyribonucleic acid; Ds, double stranded; EBV, Epstein-Barr virus; ENA, extractable nuclear antigen; FMC, flow cytometry; HBV, hepatitis B virus; HCV, hepatitis C virus; HIV, human immunodeficiency virus; Hs, high-sensitive; IFN, interferon; MiCMA, mitoxantrone, carboplatin, aracytin, and methylprednisolone; NT-proBNP, N-terminal prohormone of brain natriuretic peptide; PCR, polymerase chain reaction, R-CHOP, rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine, prednisone; WBC, white blood cell.
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