Colchicine for steroid-resistant recurrent pericarditis in a child

Abstract

Recurrent pericarditis is rare in children and is considered idiopathic in most cases. Its course is chronic, and preventing recurrences is important for the patient’s quality of life. Although a treatment strategy in pediatric recurrent pericarditis has not yet been established, non-steroidal anti-inflammatory drugs (NSAIDs) are the most common treatment for management of this condition, followed by corticosteroids, colchicine, immunosuppressive agents, immunoglobulins, and interleukin-1β receptor antagonists (e.g. anakinra). Herein, we report a case of recurrent pericarditis with pericardial effusion in a 5-year-old child who presented with fever and epigastric pain. He responded poorly to NSAIDs and corticosteroid therapy, but was successfully treated with colchicine.

Pediatric Pericarditis: Update

“…Adult pericarditis guidelines recommend colchicine in the management of acute pericarditis as an adjunct to NSAID therapy (class I recommendation, level of evidence A) as well as in recurrent Colchicine therapy for treatment of pediatric pericarditis was described initially in case reports, with some descriptions of clinical improvement in pericarditis symptoms and freedom from recurrences [79], with other reports detailing patients continuing to have recurrences of disease even after colchicine addition to corticosteroid therapy [29]. Encouragingly, some reports portrayed colchicine as allowing for the weaning and discontinuation of steroids in individuals with steroid-dependent recurrent pericarditis [80,81]. The single multicenter description of colchicine use in pediatric pericarditis described it as a frequently used therapy (62% of cases), and that treatment with colchicine was associated with a significant decrease in the rate of recurrence (3.7 per year to 1.4 per year) [26••].…”