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Case Reports
. 2023 Oct 5:25:102043.
doi: 10.1016/j.jaccas.2023.102043. eCollection 2023 Nov 1.

Successful Treatment of Recurrent Pericarditis With Rilonacept in Acute Promyelocytic Leukemia

Mustafa Atar  1 , Muhammad Majid  1   2 , Zachary Yaker  1 , Ankit Agrawal  1 , Aro Daniela Arockiam  1 , Aaron T Gerds  3 , Tahir Kafil  1 , Thomas Shimshak  2 , Chad Brands  2 , Allan L Klein  1
Affiliations
Case Reports

Successful Treatment of Recurrent Pericarditis With Rilonacept in Acute Promyelocytic Leukemia

Mustafa Atar et al. JACC Case Rep. .

Abstract

A 40-year-old woman presented with recurrent pericarditis and pericardial effusion while receiving treatment with all-trans retinoic acid and arsenic trioxide for recently diagnosed acute promyelocytic leukemia. She was successfully treated with the interleukin-1 inhibitor rilonacept after experiencing multiple recurrences with triple therapy with aspirin, colchicine, and steroids. (Level of Difficulty: Advanced.).

Keywords: acute promyelocytic leukemia; all-trans retinoic acid; arsenic trioxide therapy; pericarditis.

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Conflict of interest statement

Dr Klein has received research funding from Kiniksa Pharmaceuticals, Ltd; and has served on scientific advisory boards for Kiniksa Pharmaceuticals, Ltd, Swedish Orphan Biovitrum AB, Cardiol Therapeutics, and Pfizer, Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Electrocardiogram Showing Diffuse ST-Segment Elevation and PR Segment Depression Note ST-segment elevation (red arrows) and PR depression (blue arrows) in this patient with acute pericarditis.
Figure 2
Figure 2
CT of Chest (A) Baseline view showing presence of a small to moderate pericardial effusion (yellow arrows). (B) View after initiation of rilonacept without evidence of pericardial effusion.
Figure 3
Figure 3
Echocardiogram Apical 4 chamber view demonstrating moderate pericardial effusion without tamponade (yellow arrow).
Figure 4
Figure 4
Cardiac Magnetic Resonance Increased signal intensity on T2 STIR (yellow arrows) (A) and moderate late gadolinium enhancement (LGE) (red arrows) along with moderate circumferential pericardial effusion (white arrow) (B). After treatment, marked improvement of edema on T2 short tau inversion recovery (C) and mild LGE (orange arrows) (D).
Figure 5
Figure 5
Treatment Algorithm for Recurrent Pericarditis
See this image and copyright information in PMC

References

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