Intrapericardial corticosteroid therapy for pericardial effusion is an uncommon practice. We had an initial experience with this therapeutic measure but this was our first attempt in the context of malignant diseases and paraneoplastic syndrome. A patient with relapsed Acute Lymphoblastic Leukemia and recurrent pericardial effusion presented. She had been treated by pericardiocenthesis and systemic corticosteroids on two occasions. Following the second pericardiocenthesis and pericardial drainage, methylprednisolone was injected into the pericardium prior to withdrawal of the draining catheter. The patient had a dramatic clinical improvement with a short hospital stay and a lower dose of systemic steroids. We conclude that Intrapericardial steroids injection may be beneficial for patients with paraneoplastic syndrome and pericardial effusion. Copyright © 2011 John Wiley & Sons, Ltd.