Running into trouble: exercise-exacerbated recurrent pericarditis—a case report

Recurrent pericarditis is an inflammatory condition characterized by symptom recurrence after an initial episode. Exercise-induced flares are underrecognized.

A 53-year-old male presented with recurrent pericarditis, initially diagnosed in June 2020 and inadequately treated with a three-month colchicine course. He experienced four exercise-induced flares coinciding with triathlon training, each resolving spontaneously. In August 2024, the patient presented with severe right shoulder pain and tachycardia. Diagnostic evaluation revealed a moderate pericardial effusion, prompting a pericardial window. Despite colchicine and NSAIDs, symptoms recurred, and MRI confirmed active pericarditis with late gadolinium enhancement of the pericardium. Given the refractory nature of his disease, biologic therapy with rilonacept was initiated.

This case highlights the association between high-intensity exercise and recurrent pericarditis, underscoring the need for individualized treatment strategies, including biologics. It contributes to the understanding of refractory cases and exercise-induced inflammation.