Recurrent Acute Pericarditis Complicated by Constriction in T-Cell Acute Lymphoblastic Leukemia: Role of Multimodality Imaging.

BACKGROUND

Recurrent pericarditis affects up to 30% of patients after an initial episode, with the majority of recurring episodes occurring within 18 months. Younger age, subacute presentations, and initial treatment with steroids rather than colchicine are risk factors. Incorporation of multimodality imaging is essential in the diagnosis and management of recurrent pericarditis, particularly in complex cases.

CASE SUMMARY: A 32-year-old man was diagnosed with T-cell acute lymphoblastic leukemia (T-ALL) and recurrent acute pericarditis complicated by constriction. Management included multimodality imaging, colchicine, nonsteroidal anti-inflammatory drugs (NSAIDs), strategic dosing of steroids, and weaning based on chemotherapy and clinical response. Cardiac magnetic resonance (CMR) guided treatment adjustments, demonstrating constrictive physiology and status of inflammation.

DISCUSSION: This case highlights the role of multimodality imaging in the diagnosis and management of recurrent pericarditis in the setting of acute leukemia, enabling detailed assessment of inflammation and guiding treatment. Emerging therapies, such as interleukin (IL)-1 blockers, offer promising options for refractory cases, although their role in malignancy requires further study.