Recurrent Pericarditis in a Rugby Player: Imaging-Guided Therapy.

backgroundRecurrent pericarditis in young athletes is challenging, as relapse risk, treatment duration, and return to play must be balanced. CASE SUMMARY: A 26-year-old rugby player developed recurrent pericarditis after atrial septal defect repair. At initial presentation, she had moderate pericardial late gadolinium enhancement on cardiac magnetic resonance (CMR) and a high pericarditis risk score, and she achieved clinical remission on rilonacept. At taper initiation, she was asymptomatic with normal inflammatory biomarkers yet showed mild residual late gadolinium enhancement on CMR. After tapering of rilonacept, she relapsed 11 months later but responded rapidly to reinitiation of therapy. DISCUSSION: This case highlights the challenges of recurrent pericarditis in a high-risk athlete and discusses athlete-specific considerations, including exercise restriction and individualized return to activity. It also suggests that serial CMR and clinical risk scores may provide supportive context for cautious tapering, although evidence remains limited. TAKE-HOME MESSAGES: This case demonstrates the complexity of recurrent pericarditis management in a high-risk athlete despite clinical and CMR improvement. Serial CMR and clinical risk scores may provide supportive, hypothesis-generating context for individualized care and cautious tapering.