The management of refractory recurrent
pericarditis is challenging. Previous clinical reports have noted a beneficial effect of high-dose intravenous human
immunoglobulins (IvIgs) in isolated and systemic inflammatory disease-related forms. In this article, we analyzed retrospectively our clinical experience with
IvIg therapy in a series of clinical cases of
pericarditis refractory to conventional treatment. We retrospectively analyzed 9 patients (1994 to 2010) with refractory recurrent
pericarditis, who received high-dose
IvIg as a part of their medical treatment. Nonsteroidal anti-inflammatory drugs (
NSAIDs),
steroids, or
colchicine treatment was not discontinued during
IvIg treatment. No patients had a history of autoimmune or
connective tissue diseases. During an average period of 11 months from the first recurrence, patients had experienced a mean of 5 relapses before the first
IvIg treatment. In 4 cases, patients showed complete clinical remission with no further relapse after the first
IvIg cycle. Two patients experienced a single minor relapse, responsive to short-term nonsteroidal anti-inflammatory drugs. In 2 patients, we performed a second cycle of
IvIg after a recurrence of
pericarditis, with subsequent complete remission. One patient did not respond to 3 cycles of
IvIg and subsequently underwent pericardial window and long-term immunosuppressive treatment. No major adverse effect was observed in consequence of
IvIg administration in all the cases. In conclusion, although
IvIg mode of action is still poorly understood in this setting, this treatment can be considered as an option in patients with recurrent
pericarditis refractory to conventional medical treatment and, in our small series, has proved to be effective in 8 of 9 cases.