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CLINICAL RESEARCH: PEDIATRIC CARDIOLOGY

Recurrent pericarditis in children and adolescents

Report of 15 cases

Marja Raatikka, MD^*, Pirkko M. Pelkonen, MD^*, Jouko Karjalainen, MD^,* and Eero V. Jokinen, MD^*

^* Department of Pediatrics, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
Central Military Hospital, Helsinki, Finland

Manuscript received October 18, 2002; revised manuscript received March 12, 2003, accepted April 4, 2003.

^* Reprint requests and correspondence: Dr. Jouko Karjalainen, Central Military Hospital, Box 50, 00301, Helsinki, Finland.
jouko.karjalainen{at}pp.inet.fi

OBJECTIVES: The aim of this study was to analyze the clinical findings, course, and treatment of recurrent pericarditis (RP) in patients with onset in childhood and adolescence.

BACKGROUND: Recurrent pericarditis is a chronic condition that has presented problems in management. Knowledge about this disease is based on observations in adults, and no series of children has previously been published.

METHODS: Fifteen children (nine males, six females) in whom pericarditis had recurred at least twice were encountered in the period 1985 to 1998. Their age at onset was 6.5 to 16.8 years (mean 11.6 years), and the follow-up was 4.0 to 16.2 years (mean 8.0 years).

RESULTS: Recurrent pericarditis was preceded by open-heart surgery by 1 month to 5 years earlier in 7 of 15 patients. The six children with an atrial septal defect (ASD) had an operation at an older age (mean 9.9 years) than usual (mean 4.8 years). The risk of RP in children operated on for ASD at the age of six years or later was 5%. An initial attack of pericarditis was associated with pleuritis and/or pneumonia in 10 of 15 patients and with colitis in 2 of 15 patients During follow-up, the patients had 2 to 30 recurrences (mean 9.9). Later attacks tended to be milder. At the end of follow-up, 7 patients had been without attacks for 4 years, whereas after 4 to 16 years, the remaining patients still had active disease. No instance of constriction was found. Altogether, 11 of 15 patients were treated with corticosteroids. However, corticosteroids, whether alone or with methotrexate (n = 5), azathioprine (n = 1), cyclosporine (n = 1), or colchicine (n = 4) did not prevent recurrences.

CONCLUSIONS: The most frequent background for RP in children was the closure of ASD after the age of six years. Its course was unpredictable and often chronic, irrespective of the underlying cause or the therapy given. Colchicine did not prevent relapses.

Abbreviations and Acronyms   ASD   atrial septal defect   CRP   C-reactive protein   NSAID   nonsteroidal anti-inflammatory drug   RP   recurrent pericarditis

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