{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T22:54:48Z","timestamp":1775170488990,"version":"3.50.1"},"reference-count":18,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T00:00:00Z","timestamp":1761264000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,31]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Recurrent pericarditis is the most common and troublesome complication of pericarditis and can be particularly challenging when it becomes refractory to conventional therapies, often resulting in a prolonged disease course. Interleukin-1 (IL-1) inhibitors have transformed the management of such cases; however, not all patients tolerate or respond adequately to these agents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>We present a 37-year-old man suffering from idiopathic recurrent pericarditis since the age of 25. After failure of standard therapies, he became corticosteroid-dependent, so treatment with anakinra (an IL-1 inhibitor) was attempted twice, but discontinued early due to allergic reactions. As the recurrences were always characterised by an overt inflammatory phenotype (characterised by fever, increased C-reactive protein, and pericardial effusion), we administered off-label tocilizumab (an IL-6 receptor antagonist) as a last treatment option. The patient gained rapid benefit and was able to discontinue steroid therapy during the 6-month follow-up, achieving complete recovery from pericarditis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Interleukin-6 is a key cytokine in the pathogenesis of pericarditis, acting synergistically with IL-1 to drive inflammation and acute phase responses. In our patient, blockade of IL-6 with tocilizumab led to the complete resolution of inflammation, suggesting a possible new therapeutic option for refractory cases. This result highlights the potential of IL-6 inhibition as an alternative strategy, when IL-1 blockers are contraindicated or ineffective.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytaf535","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T12:25:22Z","timestamp":1761222322000},"source":"Crossref","is-referenced-by-count":2,"title":["Tolicizumab: a new option for refractory idiopathic recurrent pericarditis: a case report"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0008-4630","authenticated-orcid":false,"given":"Valentino","family":"Collini","sequence":"first","affiliation":[{"name":"Cardiothoracic Department, University Hospital Santa Maria Della Misericordia, ASUFC, Piazzale Santa Maria della Misericordia 15, 33100 Udine ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Venturelli","sequence":"additional","affiliation":[{"name":"Cardiothoracic Department, University Hospital Santa Maria Della Misericordia, ASUFC, Piazzale Santa Maria della Misericordia 15, 33100 Udine ,","place":["Italy"]},{"name":"Department of Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste , Trieste ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Filippo","family":"Quinzani","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Hospital of Cremona , Cremona ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberta","family":"Sappa","sequence":"additional","affiliation":[{"name":"Cardiothoracic Department, University Hospital Santa Maria Della Misericordia, ASUFC, Piazzale Santa Maria della Misericordia 15, 33100 Udine ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5722-0245","authenticated-orcid":false,"given":"Massimo","family":"Imazio","sequence":"additional","affiliation":[{"name":"Cardiothoracic Department, University Hospital Santa Maria Della Misericordia, ASUFC, Piazzale Santa Maria della Misericordia 15, 33100 Udine ,","place":["Italy"]},{"name":"Department of Medicine (DMED), University of Udine , Udine ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,10,24]]},"reference":[{"key":"2025110820234041100_ytaf535-B1","doi-asserted-by":"crossref","first-page":"3952","DOI":"10.1093\/eurheartj\/ehaf192","article-title":"ESC Scientific Document Group. 2025 ESC guidelines for the management of myocarditis and pericarditis","volume":"46","author":"Schulz-Menger","year":"2025","journal-title":"Eur Heart J"},{"key":"2025110820234041100_ytaf535-B2","doi-asserted-by":"crossref","first-page":"29","DOI":"10.2459\/JCM.0000000000001684","article-title":"Update on the diagnosis and treatment of pericardial diseases: a position paper of the Italian Society of Cardiology in collaboration with the study group on cardiomyopathies and pericardial diseases","volume":"26","author":"Imazio","year":"2025","journal-title":"J Cardiovasc Med (Hagerstown)"},{"key":"2025110820234041100_ytaf535-B3","doi-asserted-by":"crossref","first-page":"1522","DOI":"10.1056\/NEJMoa1208536","article-title":"A randomized trial of colchicine for acute pericarditis","volume":"369","author":"Imazio","year":"2013","journal-title":"N Engl J Med"},{"key":"2025110820234041100_ytaf535-B4","doi-asserted-by":"crossref","first-page":"420","DOI":"10.2459\/JCM.0000000000001618","article-title":"Medical therapy of pericarditis: tips and tricks for clinical practice","volume":"25","author":"Imazio","year":"2024","journal-title":"J Cardiovasc Med (Hagerstown)"},{"key":"2025110820234041100_ytaf535-B5","doi-asserted-by":"crossref","first-page":"409","DOI":"10.7326\/0003-4819-155-7-201110040-00359","article-title":"CORP (COlchicine for recurrent pericarditis) investigators. 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