Work

Treatment of pediatric severe acute myopericarditis with anakinra: a case report and literature review

Year: 2025

Type: article

Abstract: Acute myocarditis (AM) is an inflammation of the myocardium with a rapid onset of typically <1 month. The use of anakinra (ANK) for treating inflammatory AM in adults has been recently described; however, while some reports are promising, its efficacy remains debated. Here, we present a case of severe AM with concomitant systemic symptoms [fever, elevated C-reactive protein (CRP)] in a pediatric patient who was successfully treated with high-dose ANK. A literature review of similar published cases is also presented. A 14-year-old boy was admitted for AM with concomitant pericarditis. At disease onset, the patient presented with high fever and elevated CRP (163 mg/L) and troponin I (14,816 ng/L). Treatment with ibuprofen (30 mg/kg/day), intravenous immunoglobulin (80 g in 24 h), and colchicine (0.5 mg per day) were initiated without benefit and with further worsening of contractile function [Ejection Fraction (EF) 26%]. Consequently, inotropic support and intravenous methylprednisolone were started, leading to a partial improvement of EF (45%). Due to the inability to reduce inotropic support, a rescue treatment with ANK (7 mg/kg/day) in continuous intravenous infusion was started, resulting in progressive improvement and normalization of left ventricular systolic function. Our literature review identified five case reports of pediatric AM successfully treated with ANK. Most cases presented elevated inflammatory markers (ferritin and CRP) and/or concomitant pericarditis. We conclude that ANK, especially at high doses, may be useful for treating severe pediatric AM, particularly when associated with severe inflammation and/or pericarditis.

Source: Frontiers in Pediatrics

DOI: 10.3389/fped.2025.1544126

Authors: Francesco Licciardi, Federico Fornari, Francesca Ferroni, Carlotta Covizzi, Chiara Riggi, Davide Montin

Institutions: Ospedale Regina Margherita, University of Turin, Azienda Ospedaliera Citta' della Salute e della Scienza di Torino

Language: English

Topic: Viral Infections and Immunology Research

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,801