Recurrent pericarditis in children: elevated cardiac autoantibodies.
Recurrent pericarditis is a rare disease in childhood. Nevertheless, it may represent a challenge to the clinician due to its resistance to anti-inflammatory treatment. The initial etiology often remains unclear; specific laboratory parameters predicting the frequency or severity of the recurrences are lacking. We report on four patients with recurrent pericarditis in whom antimyolemmal antibodies (AMLAs) were detected. A prolonged persistence of IgM-type AMLAs was found in three patients: two of them presented with acute inflammation as the initial event and one with 48 recurrences during 5.5 years. The fourth patient showed a fast conversion from IgM to IgG-type AMLAs after a less acute initial presentation and showed 4 mild recurrences during the 48-month follow-up.


CONCLUSIONS
We were able to detect AMLAs in four children with recurrent pericarditis. This finding may be attributed to an auto-immunological disease following a first, acute event. We propose the detection of AMLAs in all children with unexplained recurrent pericarditis. Pediatric patients with a persistence of IgM-type AMLAs may face frequent recurrences and should be monitored therefore more closely. In addition, medical treatment may be changed in these patients with a slower tapering of the dosage of steroidal and non-steroidal antiinflammatory drugs.
Dalla Pozza
R
R
Department of Pediatric Cardiology, University Children's Hospital, Lindwurmstr. 4, 80337, Munich, Germany. Robert.DallaPozza@med.uni-muenchen.de
Hartl
D
D
Bechtold
S
S
Urschel
S
S
Kozlik-Feldmann
R
R
Pankuweit
S
S
Belohradsky
B
B
Netz
H
H
D000208:Acute Disease; D000293:Adolescent; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001323:Autoantibodies / Q000276:immunology*; D002648:Child; D004359:Drug Therapy, Combination; D004452:Echocardiography; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology; D007075:Immunoglobulin M / Q000276:immunology; D008297:Male; D010493:Pericarditis / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology*; D011379:Prognosis; D055502:Secondary Prevention; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D001323:Autoantibodies; D005938:Glucocorticoids; D007074:Immunoglobulin G; D007075:Immunoglobulin M