Çocuk ve Adolesanlarda İdiyopatik Rekürren Perikardit
Özet
Çocuk acil servislerine göğüs ağrısı ile başvuran çocukların %5'inde akut perikardit görülür ve bu vakaların %35'i tekrarlayarak rekürren perikardit tablosuna dönüşür. Çocuklarda tedavi seçenekleri henüz standardize edilememiş olup klinik araştırmalar oldukça sınırlıdır. Hastalığın tekrarlayıcı doğası tedavi stratejilerini zorlaştırmakta, özellikle ilk ataktan sonra steroid dozunun azaltılması aşamasında sıkça relapslar yaşanmaktadır. Bu durum, dirençli vakalarda uzun süre steroid kullanımına bağlı gelişebilecek büyüme geriliği, osteoporoz ve akne gibi yan etkilerden kaçınmak adına yeni interlökin-1 (IL-1) antagonistlerine olan ilgiyi artırmıştır. Sunulan olguda, 10 yaşında idiyopatik rekürren perikardit tanısı alan bir hastaya ilk olarak non-steroid anti-inflamatuvar ilaçlar (NSAID) ve kolşisin tedavisi başlanmıştır. Ancak kolşisin tedavisi altında ve steroid dozunun azaltıldığı dönemlerde atakların tekrarlaması üzerine hastaya günlük subkutan IL-1 antagonisti (Anakinra) tedavisi uygulanmıştır. Anakinra başlangıcından sonraki 72 saat içinde klinik bulgular tamamen düzelmiş, steroid tedavisi başarılı bir şekilde kesilmiş ve takip eden iki yıllık süreçte yeni bir atak gözlenmemiştir. Bu vaka, konvansiyonel tedavilere dirençli çocukluk çağı idiyopatik rekürren perikardit hastalarında Anakinra'nın steroid biriktirici etkisini ve tedavi edici başarısını açıkça ortaya koymaktadır.
Acute pericarditis affects 5% of children presenting to pediatric emergency departments with chest pain, and 35% of these cases progress to recurrent pericarditis. Treatment options for children lack standardization, and related clinical research remains highly limited. The recurrent nature of the disease complicates management, with relapses frequently occurring during corticosteroid tapering. Long-term steroid use poses severe risks for children, including growth retardation and osteoporosis, which has heightened interest in interleukin-1 (IL-1) antagonists. In the presented case, a 10-year-old child diagnosed with idiopathic recurrent pericarditis was initially treated with non-steroidal anti-inflammatory drugs (NSAIDs) and colchicine. Due to multiple recurrences during colchicine maintenance and steroid tapering, a daily subcutaneous IL-1 antagonist (Anakinra) was initiated. Clinical symptoms completely resolved within 72 hours of Anakinra therapy, allowing successful corticosteroid discontinuation, and no further recurrences were observed during the two-year follow-up. This case demonstrates that Anakinra provides an effective, steroid-sparing treatment alternative for children with idiopathic recurrent pericarditis resistant to conventional therapies.
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