This is the first case in the literature showing the efficacy and safety of anakinra in a COVID-19-RP after failure of colchicine therapy. Although rarely reported in COVID-19, pericarditis is an expected complication of viral infections. According to the 2015 European Society of Cardiology (ESC) Guidelines, diagnosis of pericarditis can be made using two of the following four criteria: (i) pericardial chest pain, (ii) widespread saddle-shaped or concave upward ST segment elevation or PR-segment depressions on ECG (iii) new or worsening pericardial effusion and (iv) pericardial friction rub that is auscultated by placing diaphragm of the stethoscope over the left sternal border. Additional supportive findings were fever, positive inflammatory markers (leukocytosis, CRP) and evidence of pericardial inflammation by imaging [4]. Most patients with acute pericarditis have an idiopathic form which accounts for more than 80% of the cases [5]. According to recent findings, inflammasome activation is one of the main immunopathogenic pathway leading to pericardial inflammation. Interleukin (IL-1)β is the predominant cytokine activated by inflammasomes which stimulates the synthesis of cyclo-oxygenase-2 (COX-2) and prostaglandins thus leading to pericarditis [5]. Hence, treatments targeting inflammasome (colchicine), COX-2 (aspirin, ibuprofen, indomethacin) and IL-1 (anakinra) constitute the treatments options for idiopathic pericarditis [6]. Viral components and cytosolic danger signals, such as mitochondrial injury, protein aggregates, and aberrant ion concentrations can activate NLR Family Pyrin Domain Containing 3 inflammasome which in turn releases IL-1β, IL-18 and the propyroptotic factor gasdermin D [7]. In a previous study, SARS-CoV-2 has been shown to activate the NLRP3 inflammasome and induce the production of IL-18 by human macrophages by its ion channel-forming E protein and ORF8b, which are also the structural components of SARS-CoV-2 [1]. Therefore, pericarditis is an expected clinical condition in COVID-19 [9]. COVID-19 is now thought as a virus-induced immune disorder due to constellation of features observed in cytokine storm syndromes. Hypercytokinemia is considered by many to be the main driver of morbidity and mortality in COVID-19[1]. Therefore, anti-cytokine treatments, as tocilizumab (targeting IL-6), and anakinra (targeting IL-1) pathways are being investigated for the treatment of severe COVID-19 patients [1]. Based on these common pathogenetic mechanisms between idiopathic pericarditis and COVD-19, we suggest that therapeutic approach in this clinical setting might be the same also for COVID-19-RP [1]. In our case we unsuccessfully tried colchicine and indomethacin, while obtaining a rapid recovery with anakinra as for refractory cases of idiopathic recurrent pericarditis.