{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:49:46Z","timestamp":1753876186430,"version":"3.41.2"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2022,9,13]],"date-time":"2022-09-13T00:00:00Z","timestamp":1663027200000},"content-version":"vor","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,9,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The SARS-CoV-2 pandemic has led to the development of the first mRNA vaccines used in humans. These vaccines are well tolerated, safe, and highly effective; however, post-marketing surveillance is revealing potential rare adverse effects. We report a case of incessant pericarditis following administration of the second dose of mRNA-1273 SARS-CoV-2 vaccine, unresponsive to conventional therapy, and successfully treated with anakinra.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>A 30-year-old man presented to the Emergency Department for incessant pericarditis unresponsive to evacuative pericardiocentesis and conventional first-line anti-inflammatory therapy. Given the typical \u2018inflammatory phenotype\u2019 clinically characterized by fever, C-reactive protein (CRP) elevation, and leucocytosis, we decided, in agreement with the rheumatologist team, to avoid glucocorticoid and to administer anakinra. A sudden clinical and echocardiographic improvement was observed, with complete resolution of the symptoms and of the pericardial effusion; similarly, CRP values progressively decreased. The patient was discharged at home; no recurrences of pericarditis were described at clinical and instrumental follow-up made 3 months later.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Several cases of pericarditis have been described in patients who received the COVID-19 vaccination, especially with the mRNA vaccine that can induce a non-adaptive immunity response against the viral spike protein, triggering cardiac damage for a molecular mimicry mechanism; however, defined pathogenesis of pericarditis associated with mRNA vaccine is still missing. The clinical scenario described is characterized by the typical \u2018inflammatory phenotype\u2019, triggered by a disproportionate and uncontrolled activation of the inflammasome based on an interleukin-1 (IL-1) overproduction. We administered anakinra, an IL-1 blocking drug, with a sharp clinical, echocardiographic and laboratoristic improvement. The complete response observed in this case suggests that vaccine-related pericarditis could be triggered by an auto-inflammatory pathway based on IL-1 overproduction. Further research is, therefore, warranted to determine the mechanisms by which the mRNA vaccine may cause pericarditis in order to choose the most targeted therapy.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytac357","type":"journal-article","created":{"date-parts":[[2022,9,13]],"date-time":"2022-09-13T18:31:29Z","timestamp":1663093889000},"source":"Crossref","is-referenced-by-count":2,"title":["Incessant pericarditis following the second dose of SARS-CoV-2 mRNA vaccine successfully treated with anakinra: a case report"],"prefix":"10.1093","volume":"6","author":[{"given":"C","family":"Conte","sequence":"first","affiliation":[{"name":"Department of Cardiovascular and Thoracic Sciences, Catholic University of Sacred Heart , Largo Francesco Vito 1, 00168, Rome , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G","family":"Princi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Thoracic Sciences, Catholic University of Sacred Heart , Largo Francesco Vito 1, 00168, Rome , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3774-8330","authenticated-orcid":false,"given":"D","family":"D\u2019Amario","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS , Largo Francesco Vito, 1\u201300168 Rome , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T","family":"Sanna","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS , Largo Francesco Vito, 1\u201300168 Rome , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D","family":"Pedicino","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS , Largo Francesco Vito, 1\u201300168 Rome , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G","family":"Liuzzo","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. 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