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We report a case of metastatic pancreatic neuroendocrine carcinoma associated with paraneoplastic Cushing’s syndrome, successively treated with five lines of treatment (platin-etoposide, LV5FU2-dacarbazine, FOLFIRINOX, pembrolizumab, and paclitaxel) and anti-secretory treatment. Circulating-free DNA (cfDNA) was analysed at each morphological evaluation starting from the second-line treatment. cfDNA changes were well correlated with the disease course, and cfDNA may be used as a predictive marker and/or as an early marker of response. In addition, the absolute count of atypical cells was elevated upon disease progression.

Objective We aimed to investigate the remission rate and disease duration in idiopathic or post–cardiac injury pericarditis and risk factors for disease duration and anti–interleukin‐1 (IL‐1) agent discontinuation. Methods This was a multicenter, longitudinal, observational study including 370 patients (51.4% female). The remission rate was the proportion of patients who stopped all pericarditis‐related therapies for at least 6 months without recurrences. Results The median follow‐up was 4.9 (interquartile range [IQR] 2.8–8.4) years, and the median age at the end of follow‐up was 49 (IQR 37–60) years. A median of 1.1 (IQR 0.6–1.9) recurrences/year and 0.4 (IQR 0.1–0.9) hospitalizations/year were recorded. The remission rate at follow‐up was 34.0%, 7% per year. Disease duration was shorter for patients in remission (3.1 years, IQR 1.6–6.2 years) than for those still receiving treatment (4 years, IQR 2.2–7.8; P = 0.02). Use of “guidelines‐based therapy” (hazard ratio [HR] 1.85, 95% confidence interval [CI] 1.25–2.73; P = 0.02) and colchicine use at first attack (HR 1.51, 95% CI 1.02–2.23; P = 0.038) were protective factors, whereas steroid use was associated with longer disease duration (HR 0.53, 95% CI 0.35–0.81; P = 0.003). Corticosteroids were used in 77.3% of patients, with a median duration of therapy of 1.1 (IQR 0.4–2.6) years. Anakinra was used in 25.9% with a median duration of therapy of 2.4 (IQR 0.9–5.0) years; only 19.8% were able to stop anakinra at the end of observation period. Conclusion This study reports the largest and longest follow‐up in patients with recurrent pericarditis. Guideline adherence from the first attack is associated with a shorter course. The disease was long and impacting in terms of recurrences and hospitalizations, often requiring a long‐term treatment, in particular with anti–IL‐1 agents.

BackgroundAcute pericarditis represents an inflammatory disease affecting the pericardial layers. In developed countries more than 80% of pericarditis are defined as idiopathic, less frequently they are secondary to other conditions such as infections, rheumatic or systemic inflammatory diseases, cancer, post–cardiac injury syndromes and radiation therapy (RT).Case presentationWe reported a case of a patient with acute pericarditis that occurred a few hours after chest radiation therapy, performed for breast cancer. After the failure of first-line therapy, we introduced anakinra, an anti- interleukin-1 (IL-1) agent, observing an immediate clinical and instrumental response.ConclusionsOur experience highlights the efficacy and safety profile of anakinra in early stages of acute pericarditis with an inflammatory phenotype. To the best of our knowledge, there is no data supporting the use of anakinra in the treatment of RT induced acute pericarditis.

Tetanus is an infectious disease caused by Clostridium tetani toxin. Although easily preventable through vaccination, over 73,000 new infections and 35,000 deaths due to tetanus occurred worldwide in 2019, with higher rates in countries with healthcare barriers. Here, we present a clinical case of C. tetani infection in an 85-year-old patient. Patient robustness and high functional reserve before infection are favorable predictors of survival for an otherwise fatal disease. However, the patient did not experience any severe complications. Therefore, this report is a strong call for tetanus vaccination.

Diseases of the pericardium encompass a spectrum of conditions, including acute and recurrent pericarditis, where inflammation plays a pivotal role in the pathogenesis and clinical manifestations. Anti-inflammatory therapy indeed forms the cornerstone of treating these conditions: NSAIDs, colchicine, and corticosteroids (as a second-line treatment) are recommended by current guidelines. However, these medications come with several contraindications and are not devoid of adverse effects. In recent years, there has been an increased focus on the role of the inflammasome and potential therapeutic targets. Recurrent pericarditis also shares numerous characteristics with other autoinflammatory diseases, in which interleukin-1 antagonists have already been employed with good efficacy and safety. The objective of this review is to summarize the available studies on the use of anti-IL-1 drugs both in acute and recurrent pericarditis.