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Difficult-to-treat recurrent pericarditis after SARS-CoV-2 vaccination
Michele Marchetta1, Rocio I Lopez1, Michele Golino2
1Berne Cardiovascular Research Center and Division of Cardiology, University of Virginia, Charlottesville, VA, USA.
International Journal of Cardiology
|June 16, 2025
Summary
Pericarditis after COVID-19 vaccination can be difficult to treat. Effective management may involve IL-1 blockade therapy to resolve symptoms and prevent complications.
Area of Science:
- Cardiology
- Immunology
- Vaccinology
Background:
- Pericarditis is a rare complication of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) vaccination.
- While often self-limited, some cases become recurrent and challenging to manage, with unclear pathophysiology.
- Vaccine-induced immune activation and inflammasome pathways are suspected contributors.
Purpose of the Study:
- To report on difficult-to-treat pericarditis cases following SARS-CoV-2 vaccination.
- To describe clinical characteristics, treatment approaches, and outcomes.
- To highlight the potential role of IL-1 blockade in refractory cases.
Main Methods:
- Retrospective case series of eight patients with difficult-to-treat pericarditis post-SARS-CoV-2 vaccination.
- Diagnosis according to ESC 2015 guidelines; exclusion of acute SARS-CoV-2 infection.
- Review of treatments including NSAIDs, colchicine, corticosteroids, and rilonacept.
Main Results:
- Median age 56 years; most received mRNA vaccines (Pfizer-BioNTech, Moderna).
- Chest pain was universal; six patients had pericardial effusion, one developed tamponade.
- Six patients responded to rilonacept after failure of conventional therapies, achieving complete symptom resolution.
Conclusions:
- SARS-CoV-2 vaccine-associated pericarditis can be recurrent and difficult to manage.
- Interleukin-1 (IL-1) blockade may be crucial for treating refractory cases by disrupting autoinflammatory cycles.
- Early recognition and escalated therapy, including IL-1 inhibition, are vital to minimize morbidity.
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