Cardiac tamponade as the initial presentation of systemic lupus erythematosus: a case report and review of the literature

Abstract

Systemic lupus erythematosus (SLE) is an autoimmune disease that can involve any organ system, exhibiting great diversity in presentation. Cardiac tamponade as the initial presentation of childhood onset SLE (cSLE) is rare. We report the case of a 10 year old Afro-Caribbean female who presented with complaints of chest pain, shortness of breath and fever over 4 days. Clinical examination strongly suggested cardiac tamponade which was confirmed by investigations and treated with pericardiocentesis. After a thorough investigation, the underlying diagnosis of SLE was confirmed using the Systemic Lupus International Collaborating Clinics (SLICC) criteria and high dose corticosteroid therapy initiated. A review of recent studies shows that common initial presentations of cSLE include constitutional symptoms, renal disease, musculoskeletal and cutaneous involvement. In presenting this case and reviewing the literature we emphasize the importance of cSLE as a differential diagnosis when presented with pericarditis in the presence or absence of cardiac tamponade. In these patients early diagnosis and treatment is desired and in this regard we also discuss the sensitivity of the SLICC criteria in cSLE.Electronic supplementary materialThe online version of this article (doi:10.1186/s12969-015-0005-0) contains supplementary material, which is available to authorized users.

Cardiac tamponade in a patient with autoimmune polyglandular syndrome type 2

“…It may be asymptomatic or clinically significant due to large pericardial effusion. Echocardiography confirms that the diagnosis and fluid removal by pericardiocentesis and corticosteroid administration are needed for management ( 13 ). In rare cases, cardiac tamponade occurs and sometimes it can be the presenting symptom ( 14 ), while low C4 levels have been found to be predictive of this life-threating situation in adult patients ( 15 ).…”

Infectious and Noninfectious Acute Pericarditis in Children: An 11-Year Experience

“…Pericarditis is a common manifestation of juvenile rheumatoid arthritis and the most common cardiac complication of systemic lupus erythematosus [ 30 , 31 , 33 ]. In our study, pericardial effusions were diagnosed at time of presentation of 2 patients with systemic onset JIA and 4 with SLE, including one who had cardiac tamponade; a rare initial presentation of childhood SLE [ 34 ]. Surgical drainage is generally not needed in patients with collagen vascular disease and improvement occurs with medical therapy alone [ 33 ].…”

“…Complications of acute pericarditis include cardiac tamponade, recurrence, and constrictive pericarditis [ 34 , 44 , 47 ]. Cardiac tamponade occurs when excessive pericardial fluid leads to increase intrapericardial pressure causing impaired cardiac filling and reduced cardiac output.…”

Pericarditis y derrame pericárdico como presentación inicial de lupus eritematoso sistémico. Reporte de caso

“…Específi camente SLICC 2012 menciona que se debe contar al menos con un criterio clínico y uno inmunológico, o con una biopsia compatible con nefritis y autoanticuerpos positivos (ANA o anti-ADN). 18,19,20,21,22 En el caso presentado se demostró positividad para autoinmunidad con cuatro criterios ACR y siete SLICC de forma inicial y durante el seguimiento emergió un segundo criterio clínico (cua-dro 1). Se administró tratamiento inmunosupresor para evitar episodios de recurrencia y complicaciones por falla orgánica que conllevan elevada morbimortalidad.…”