Biologic Rescue With Tocilizumab

BACKGROUND: Pericardial effusions in systemic sclerosis (SSc) are usually mild; large or refractory effusions are rare. CASE SUMMARY: A 63-year-old woman with diffuse cutaneous SSc, interstitial lung disease, and secondary Sjögren syndrome presented with worsening dyspnea and a large chronic pericardial effusion. Despite pericardiocentesis, drain repositioning, colchicine, corticosteroids, and surgical pericardial window, she had persistent high-output drainage. Tocilizumab, an interleukin-6 (IL-6) receptor antagonist, was initiated for suspected autoimmune serositis, resulting in rapid decline in pericardial drain output and sustained improvement on serial transthoracic echocardiography. DISCUSSION: This case highlights IL-6-driven inflammatory serositis as a mechanism of refractory pericardial effusion in SSc and demonstrates the therapeutic benefit of IL-6 receptor blockade. TAKE-HOME MESSAGE: IL-6-mediated serositis should be considered in refractory SSc effusions; tocilizumab may be effective when standard therapies fail.