Massive Hemorrhagic Pericardial Effusion With Cardiac Tamponade as Initial Manifestation of Mixed Connective Tissue Disease

Abstract

Mixed connective tissue disease (MCTD) is a distinct entity of connective tissue disorders characterized by overlapping clinical features of various autoimmune diseases along with the presence of antibodies to ribonucleoprotein (anti-RNP). The prevalence of cardiac involvement in MCTD varies from 13% to 65% and accounts for approximately 20% of MCTD related mortality. In this case, we describe an elderly female patient with multiple complaints without a clear etiology on presentation. Echocardiogram revealed severe rapidly accumulating pericardial effusion causing tamponade necessitating pericardial window. Laboratory investigations showed positive ribonucleoprotein antibodies. Biopsy of pericardial tissue revealed fibrinous pericarditis. While pericarditis is commonly associated with MCTD, pericardial tamponade on the other hand is rarely described. This case highlights a very rare complication of the disease. Early recognition, prompt treatment, and regular follow-up with serial echo are essential for treatment.

SARS-CoV-2 Complicated by a Large Hemorrhagic Pericardial Effusion

“…Pericardial effusions can occur in the setting of several infectious and noninfectious conditions, whereas hemorrhagic effusions are usually caused by underlying malignancy, percutaneous intervention (PCI), as a complication of myocardial infarction [ 1 ], postpericardiotomy syndrome, trauma, or in the setting of mixed connective tissue disease [ 2 ]. The effusion may be transudative, exudative, or hemorrhagic depending on the etiology.…”

A Patient Presented with High Fever and Bloody Pericardial Effusion (Hemorrhagic Pericarditis)

“…In another retrospectives single USA medical center in the 1990s, hemorrhagic pericarditis causes were etiologically diverse, the leading causes detected in the 96 patients were: iatrogenic 31%, Malignancy 26%, Complications of acute myocardial infarction 11%, idiopathic 10%, uremic 7% and M. tuberculosis was rare among the other causes (1 patient) which was diagnosed as a postmortem [4]. In addition, mixed connective tissues disease and infliximab were added to the causes in some reports [5][6] In the current case, we report a case of hemorrhagic pericarditis in a patient who was initially presented in Sudan with chest pain, prostration, and fever. Workup did not reveal the etiology of his illness, he presented to Al Khalidi hospital for evaluation, and hemorrhagic pericarditis due to M. tuberculosis was firmly diagnosed.…”