Viral pericarditis today: Challenges in diagnosis and therapy illustrated by a “typical” clinical case

According to modern concepts, pericarditis is a more complex condition than was previously thought. A clinical case is presented in which, as often happens, the symptoms of pericarditis were mistaken for radicular syndrome and an acute respiratory viral infection; therefore, adequate treatment was not initially administered. It led to hyperactivation of autoinflammation, which colchicine and nonsteroidal anti-inflammatory drugs failed to control, and required high doses of glucocorticosteroids. However, at this stage, probably due to the destruction of cardiomyocytes, the activation of the autoimmune processes has already occurred, which resulted in the relapsing disease. Further management was associated with challenges in differential diagnosis, decision-making regarding the use of reserve drugs - interleukin-1 inhibitors and immunoglobulin - and the treatment of complications. It took about 1.5 years to achieve stable remission, made possible by the coordinated work of the cardiology and rheumatology centers.