Post-cardiac Injury Syndrome in a Systemic Lupus Erythematosus Patient After an Open-Heart Operation: A Case Report

Abstract

Post-cardiac injury syndrome (PCIS) is an inflammatory condition caused by a cardiac injury that can affect the pericardium, pleura, or both. We describe a female patient who underwent heart surgery and thereafter developed pericardium and pleural effusion. She was also known to have systemic lupus erythematosus (SLE). Due to the possibility that each of these symptoms could impact the pericardium or pleura, we came to the conclusion that they could be caused by either PCIS, SLE, or both.A 54-year-old woman underwent open heart surgery three weeks ago and required aortic valve replacement and coronary artery bypass grafting (CABG). She presented to the emergency room complaining of fatigue, chest pain, shortness of breath, coughing, and fever for five days. She had a history of SLE for seven years. The patient was found to have a right-side pleural effusion, a pericardial effusion, and a high inflammatory marker based on imaging and laboratory evaluations. A right pleural-side image-guided percutaneous pigtail catheter drainage was inserted. Exudative fluid appeared in the pleural fluid analysis, and a mild pericardial effusion was seen on echocardiography. The patient was diagnosed with pericarditis and treated with prednisone, colchicine, and antibiotics. Six days later, she was discharged in good general condition.In this particular case of SLE with a chronic inflammatory reaction, PCIS developed following valve replacement surgery. The activation and destruction of endothelial cells are frequently seen in both SLE and PCIS, leading us to believe that there may be a possible reciprocal interaction between these two distinct autoimmune illnesses.