Recurrent Pericarditis Evolving to Constrictive Pericarditis and Pericardiectomy Over 18 Years

Recurrent pericarditis (RP) is a clinical condition managed with anti-inflammatory medications, with a subset of patients developing overt constriction requiring pericardiectomy.

A 38-year-old woman with idiopathic RP presented with dyspnea, lower extremity edema, and chest pain after years of relapsing disease not adequately controlled by nonsteroidal anti-inflammatory drugs, colchicine, and corticosteroids. Rilonacept was initiated late in the disease course and could not halt progression. Multimodality imaging and right heart catheterization confirmed constrictive pericarditis, and she ultimately underwent radical pericardiectomy followed by gradual recovery on tapering immunosuppression. Pathological analysis demonstrated organizing fibrous pericarditis.

This case highlights the importance of early recognition of high-risk RP, illustrates the role of multimodality imaging in guiding decision-making after pericardiectomy, and raises questions regarding the potential role and optimal timing of IL-1 inhibitors in modifying disease progression before constrictive physiology sets in.

The role and timing of biologic therapy in RP requires further research, while pericardiectomy remains definitive once fibrosis predominates.