BACKGROUNDSystemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by periods of exacerbations, interspersed with remissions. It has variable manifestations which can affect different systems of the human body. Regarding cardiac involvement, the most classic manifestations consist of pericarditis, myocarditis, cardiac block and endocarditis. However, it is observed that cardiac tamponade (CT), although rarer, is potentially fatal in patients with SLE.
CASE REPORTA 22-year-old female diagnosed 1 year ago with SLE with cutaneous-articular involvement, without follow-up, using prednisone 40 mg/day for 8 months. She was hospitalized with dyspnea at rest, oliguria and foamy urine for 5 days. She also had fever and arthralgia of her wrists and elbows for 15 days. Physical examination: blood pressure 101/69 mmHg, heart rate 133 bpm, systolic murmur in the mitral focus (4+/6+) and aortic (4+/6+), turgid jugular, bilateral basal crackles and positive Skoda's sign . Laboratory showed hemoglobin 6.8g/dL; creatinine 4.8 mg/dL; urea 178 mg/dL; albumin 2.2 g/dL, hypocomplementemia; urine with 3+ proteinuria, 2+ erythrocytes; 24-h urine with 1.8 g protein/day, characterizing nephritis lupus. Radiography showed bilateral pleural effusion with significant cardiomegaly. The patient developed acute hypervolemic pulmonary edema, indicating dialysis therapy. After 23 days, she presented hypotension, muffled heart sounds and worsening of jugular turgescence, pericardiocentesis was performed with the output of 460 mL of blood fluid, increased cellularity, predominance of neutrophils and glucose consumed. Five days later, she presented Beck's triad again, and a pericardial pleural window with pericardial biopsy was performed. Absence of vegetation ruled out infectious endocarditis. Empirical treatment with COXCIP-4 was initiated due to the possibility of pericardial tuberculosis, subsequently suspended due to lack of clinical response and signs of drug induced hepatitis. In addition, the patient had a tonic-clonic seizure, treated with pulse therapy with immunoglobulin for 5 days and pulse therapy with cyclophosphamide due to compatible neurolupus. After being hospitalized for 3 months, she was discharged with established renal and cyclophosphamide pulse therapy planned for another 6 months.
CONCLUSIONIn SLE, CT has a prevalence of only 1%. Also, there are few cases in the literature of patients with this condition. However, this report reinforces the importance of CT being remembered as a possible differential diagnosis of complications in patients with SLE. In addition, our case emphasizes the importance of early diagnosis and treatment, aiming to avoid dramatic cases like this.
