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Carvoeiro A, Mota R, Sobrosa P, Esteves A. Cardiac Tamponade and Primary Biliary Cholangitis: An Unusual Presentation and a Rare Association of Systemic Lupus Erythematosus. Cureus 2024; 16:e53501. [PMID: 38440043 PMCID: PMC10911173 DOI: 10.7759/cureus.53501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2024] [Indexed: 03/06/2024] Open
Abstract
Systemic lupus erythematosus (SLE) is a disease known for its multiple manifestations, including numerous cardiac complications. While pericardial effusions are common in patients with SLE, cardiac tamponade is rare, and it is even rarer as an initial and isolated clinical manifestation of SLE. We describe a case of a young adult woman who presented with a four-week history of shortness of breath, orthopnea, and paroxysmal nocturnal dyspnea. Chest radiography revealed a significant increase in the cardiothoracic index, and transthoracic echocardiography confirmed a life-threatening cardiac tamponade that necessitated emergency pericardiocentesis and high-dose corticosteroids. Following a thorough investigation, we excluded viral infection, malignancy, tuberculosis, and other autoimmune diseases, and the patient was diagnosed with SLE based on the Systemic Lupus International Collaborating Clinics (SLICC) criteria. In this case report, we also present an uncommon association between SLE and primary biliary cholangitis (PBC). While both are autoimmune diseases, the coexistence of these two conditions in the same patient is rare. The report highlights the need for ongoing research to better understand the optimal management strategies for patients with coexisting autoimmune conditions.
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Affiliation(s)
- Ana Carvoeiro
- Internal Medicine, Unidade Local de Saúde do Alto Minho, Viana do Castelo, PRT
| | - Rita Mota
- Internal Medicine, Unidade Local de Saúde do Alto Minho, Viana do Castelo, PRT
| | - Patrícia Sobrosa
- Internal Medicine, Unidade Local de Saúde do Alto Minho, Viana do Castelo, PRT
| | - Alexandra Esteves
- Internal Medicine, Unidade Local de Saúde do Alto Minho, Viana do Castelo, PRT
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Uccello G, Bonacchi G, Rossi VA, Montrasio G, Beltrami M. Myocarditis and Chronic Inflammatory Cardiomyopathy, from Acute Inflammation to Chronic Inflammatory Damage: An Update on Pathophysiology and Diagnosis. J Clin Med 2023; 13:150. [PMID: 38202158 PMCID: PMC10780032 DOI: 10.3390/jcm13010150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
Acute myocarditis covers a wide spectrum of clinical presentations, from uncomplicated myocarditis to severe forms complicated by hemodynamic instability and ventricular arrhythmias; however, all these forms are characterized by acute myocardial inflammation. The term "chronic inflammatory cardiomyopathy" describes a persistent/chronic inflammatory condition with a clinical phenotype of dilated and/or hypokinetic cardiomyopathy associated with symptoms of heart failure and increased risk for arrhythmias. A continuum can be identified between these two conditions. The importance of early diagnosis has grown markedly in the contemporary era with various diagnostic tools available. While cardiac magnetic resonance (CMR) is valid for diagnosis and follow-up, endomyocardial biopsy (EMB) should be considered as a first-line diagnostic modality in all unexplained acute cardiomyopathies complicated by hemodynamic instability and ventricular arrhythmias, considering the local expertise. Genetic counseling should be recommended in those cases where a genotype-phenotype association is suspected, as this has significant implications for patients' and their family members' prognoses. Recognition of the pathophysiological pathway and clinical "red flags" and an early diagnosis may help us understand mechanisms of progression, tailor long-term preventive and therapeutic strategies for this complex disease, and ultimately improve clinical outcomes.
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Affiliation(s)
- Giuseppe Uccello
- Division of Cardiology, Alessandro Manzoni Hospital—ASST Lecco, 23900 Lecco, Italy;
| | - Giacomo Bonacchi
- Division of Cardiology, Tor Vergata University Hospital, 00133 Rome, Italy;
| | | | - Giulia Montrasio
- Inherited Cardiovascular Diseases Unit, Barts Heart Centre, St. Bartholomew’s Hospital, London EC1A 7BS, UK;
| | - Matteo Beltrami
- Cardiomyopathy Unit, Careggi University Hospital, 50134 Florence, Italy
- Arrhythmia and Electrophysiology Unit, Careggi University Hospital, 50134 Florence, Italy
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3
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Moss R, Ali AM, Mahgerefteh J, Panesar LE, Pastuszko P, Murthy R, Kaushik S. Pericardiectomy for Successful Treatment of Constrictive Pericarditis in a Pediatric Patient. JACC Case Rep 2023; 23:102009. [PMID: 37954955 PMCID: PMC10635866 DOI: 10.1016/j.jaccas.2023.102009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/21/2023] [Accepted: 08/08/2023] [Indexed: 11/14/2023]
Abstract
A 15-year-old girl with history of asthma and obesity presented with recurrent anasarca without systolic heart failure or significant renal disease. She was diagnosed with constrictive pericarditis and successfully underwent pericardiectomy with pericardial stripping and a waffle procedure. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Rachel Moss
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Amr Mohamed Ali
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Peter Pastuszko
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Raghav Murthy
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Shubhi Kaushik
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
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4
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Khayata M, Wang TKM, Chan N, Alkharabsheh S, Verma BR, Oliveira GH, Klein AL, Littlejohn E, Xu B. Multimodality Cardiac Imaging in Patients with Systemic Lupus Erythematosus. Curr Probl Cardiol 2023; 48:101048. [PMID: 34774920 DOI: 10.1016/j.cpcardiol.2021.101048] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 11/05/2021] [Indexed: 02/01/2023]
Abstract
Systemic lupus erythematous (SLE) is an autoimmune disease with a wide range of cardiovascular complications. The main manifestations include diseases of the coronary arteries, valves, pericardium, and myocardium. Multimodality cardiovascular imaging techniques are critical for evaluating the extent of cardiac manifestations in SLE patients, which can provide valuable prognostic information. However, their utility has previously not been well defined. This review provides a state-of-the-art update on the cardiovascular manifestations of lupus, as well as the role of multimodality cardiac imaging in guiding management of patients with SLE.
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Affiliation(s)
- Mohamed Khayata
- Department of Cardiovascular Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Tom Kai Ming Wang
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Section of Cardiovascular Imaging, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nicholas Chan
- Department of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Saqer Alkharabsheh
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Beni R Verma
- Department of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Guilherme H Oliveira
- Department of Cardiovascular Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Allan L Klein
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Section of Cardiovascular Imaging, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Emily Littlejohn
- Department of Rheumatologic and Immunologic Disease, Cleveland Clinic, Ohio, USA
| | - Bo Xu
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Section of Cardiovascular Imaging, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
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5
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Goldar G, Garraud C, Sifuentes AA, Wassif H, Jain V, Klein AL. Autoimmune Pericarditis: Multimodality Imaging. Curr Cardiol Rep 2022; 24:1633-1645. [PMID: 36219367 DOI: 10.1007/s11886-022-01785-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE OF THE REVIEW The purpose of this review is to understand the underlying mechanism that leads to pericarditis in systemic autoimmune and autoinflammatory diseases. The underlying mechanism plays a vital role in the appropriate management of patients. In addition, we will review the current landscape of available cardiac imaging modalities with emphasis on pericardial conditions as well as proposed treatment and management tailored toward pericardial autoimmune and autoinflammatory processes. RECENT FINDINGS Approximately 22% of all cases of pericarditis with a known etiology are caused by systemic autoimmune diseases such as systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, and vasculitis. In recent years, there have been advancements of imaging modalities including cardiac MRI, cardiac CT scan, and PET scan and their respective nuances in regard to contrast use, technique, and views which clinicians may utilize to better understand the extent of a patient's pericardial pathology and the trajectory of his or her disease process. In this review, we will discuss systemic autoimmune and autoinflammatory diseases that involve the pericardium. We will also review different imaging modalities that are currently used to further characterize such conditions. Having a deeper understanding of such techniques will improve patient outcomes by helping clinicians tailor treatment plans according to the unique underlying condition.
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Affiliation(s)
- Ghazaleh Goldar
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk J1-5, Cleveland, OH, 44195, USA.
| | - Cassandra Garraud
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk J1-5, Cleveland, OH, 44195, USA
| | - Aaron A Sifuentes
- University of Michigan Department of Internal Medicine, Ann Arbor, MI, USA
| | - Heba Wassif
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk J1-5, Cleveland, OH, 44195, USA
| | - Vardhmaan Jain
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk J1-5, Cleveland, OH, 44195, USA
| | - Allan L Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk J1-5, Cleveland, OH, 44195, USA
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Emorinken A, Dic-Ijiewere MO, Izirein HO. Cardiac Tamponade, an Unusual First Presentation of Systemic Lupus Erythematosus: A Case Report in a Rural Tertiary Hospital. Cureus 2022; 14:e27989. [PMID: 36120196 PMCID: PMC9469684 DOI: 10.7759/cureus.27989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2022] [Indexed: 11/05/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a condition that manifests in a variety of ways. Although pericarditis and pericardial effusion are frequent cardiac manifestations of SLE, cardiac tamponade is rarely reported, especially as the initial manifestation of the disease. We describe a 38-year-old Nigerian lady who presented with three months of progressive dyspnea. She had intermittent fever, tachycardia, tachypnea, hypotension, jugular vein distension, and muffled heart sounds. Echocardiography confirmed cardiac tamponade. The ANA, anti-dsDNA, and anti-Sm antibodies were positive. She had a high ESR and low levels of blood complements. The diagnosis of SLE was established based on the 2019 EULAR/ACR classification criteria. She was treated with intravenous methylprednisolone, oral prednisolone, and hydroxychloroquine after undergoing an emergency echo-guided pericardiocentesis. She responded well to treatment, and she is currently being followed up on an outpatient basis. Clinicians should consider SLE as a differential when evaluating patients with pericardial effusion, as an accurate and timely diagnosis could be lifesaving.
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Abstract
Introduction COVID-19 has caused unprecedented hardships in the 21st century with more than 150 million infections. Various immunological phenomena have been described during the course of the infection, and this infection has also triggered autoimmunity. Rheumatological illnesses have been described following resolution of the acute infection; hence we sought to conduct a review of the rheumatological complications of COVID-19. Methods We conducted a literature search for articles relating to sequelae of COVID-19 from Jan 2020 to 30th April 2021. Results We found a number of reports of inflammatory arthritis after SARS-CoV-2 infection. SLE and renal disease have been described, and vasculitis also appears to be a common complication. Rhabdomyolysis and myositis has also been reported in a number of patients. We also found some evidence of large vessel vasculitis in ‘long COVID’ patients. Conclusions This review highlights a number of important complications such as inflammatory arthritis, lupus-like disease, myostis and vasculitis following SARS-CoV-2 infection.
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Pieta A, Pelechas E, Gerolymatou N, Voulgari PV, Drosos AA. Calcified constrictive pericarditis resulting in tamponade in a patient with systemic lupus erythematosus. Rheumatol Int 2020; 41:651-670. [PMID: 33206224 DOI: 10.1007/s00296-020-04747-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 10/31/2020] [Indexed: 10/23/2022]
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with multiorgan involvement, including heart. Pericarditis-the most common cardiac manifestation-occurs in up to 50% of cases, resulting in positive treatment outcomes. Rarely, it evolves to hazardous complications. A 50-year-old woman with SLE in clinical remission, receiving hydroxychloroquine 400 mg/day, presented to us with severe chest pain and low-grade fever. Physical examination revealed a friction rub and decreased breath sounds at the right lung base. Laboratory evaluation demonstrated leukopenia, thrombocytopenia, low C4 levels, and high acute phase reactants. Chest X-ray exhibited cardiomegaly, calcified pericardium, and right pleural effusion, confirmed by CT scan. PPD skin test and IGRA were both negative. Pericardial fluid, blood, and urine cultures for bacteria and fungi, as well as Gram and Ziehl-Neelsen stains were negative. Serological tests for viruses were also negative. The patient was diagnosed with calcified constrictive pericarditis (CP) due to SLE. She was treated with cyclophosphamide and methylprednisolone pulses, without improvement. Her clinical condition deteriorated, developing signs and symptoms compatible with cardiac tamponade (TMP), which was confirmed by Doppler echocardiography. The patient underwent pericardiectomy. A dramatic response was noted and she was discharged with prednisone 50 mg/day and azathioprine 100 mg/day. Thus, we review and discuss the relevant literature of SLE cases with CP or TMP. When an SLE patient presents with CP, infectious causes should be excluded first. To the best of our knowledge, this is the only case of SLE and calcified CP leading to TMP, hence physicians should be aware of this complication.
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Affiliation(s)
- Antigone Pieta
- Rheumatology Clinic, Department of Internal Medicine, School of Health Sciences, University Hospital of Ioannina, University of Ioannina, 45110, Ioannina, Greece
| | - Eleftherios Pelechas
- Rheumatology Clinic, Department of Internal Medicine, School of Health Sciences, University Hospital of Ioannina, University of Ioannina, 45110, Ioannina, Greece
| | - Nafsika Gerolymatou
- Rheumatology Clinic, Department of Internal Medicine, School of Health Sciences, University Hospital of Ioannina, University of Ioannina, 45110, Ioannina, Greece
| | - Paraskevi V Voulgari
- Rheumatology Clinic, Department of Internal Medicine, School of Health Sciences, University Hospital of Ioannina, University of Ioannina, 45110, Ioannina, Greece
| | - Alexandros A Drosos
- Rheumatology Clinic, Department of Internal Medicine, School of Health Sciences, University Hospital of Ioannina, University of Ioannina, 45110, Ioannina, Greece.
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Abstract
PURPOSE OF REVIEW We review the epidemiology, pathophysiology, and management of pericarditis most commonly complicating autoimmune and autoinflammatory conditions. RECENT FINDINGS Typically, pericarditis occurs in the context of a systemic flare of the underlying disease but infrequently, it is the presenting manifestation requiring a high index of suspicion to unravel the indolent cause. Pericardial involvement in rheumatic diseases encompasses a clinical spectrum to include acute, recurrent and incessant pericarditis, constrictive pericarditis, asymptomatic pericardial effusion, and pericardial tamponade. Direct evidence on the pathophysiology of pericarditis in the context of rheumatic diseases is scant. It is theorized that immune perturbations within pericardial tissue result from the underlying central immunopathology of the respective autoimmune or autoinflammatory disease. Pericarditis management depends on acuity, the underlying cause and epidemiological features such as patient's immune status and geographic prevalence of infections such as tuberculosis. Immunosuppressive medications including biologics such as interleukin 1 blockers emerge as possible steroid sparing agents for pericarditis treatment.
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Affiliation(s)
- Apostolos Kontzias
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Stony Brook University School of Medicine, Stony Brook, NY, USA.
| | - Amir Barkhodari
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - QingPing Yao
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Stony Brook University School of Medicine, Stony Brook, NY, USA
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10
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Mantovani Cardoso E, Hundal J, Feterman D, Magaldi J. Concomitant new diagnosis of systemic lupus erythematosus and COVID-19 with possible antiphospholipid syndrome. Just a coincidence? A case report and review of intertwining pathophysiology. Clin Rheumatol 2020; 39:2811-2815. [PMID: 32720260 PMCID: PMC7384868 DOI: 10.1007/s10067-020-05310-1] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/20/2020] [Accepted: 07/23/2020] [Indexed: 12/16/2022]
Abstract
In the midst of the COVID-19 pandemic, further understanding of its complications points towards dysregulated immune response as a major component. Systemic lupus erythematosus (SLE) is also a disease of immune dysregulation leading to multisystem compromise. We present a case of new-onset SLE concomitantly with COVID-19 and development of antiphospholipid antibodies. An 18-year-old female that presented with hemodynamic collapse and respiratory failure, progressed to cardiac arrest, and had a pericardial tamponade drained. She then progressed to severe acute respiratory distress syndrome, severe ventricular dysfunction, and worsening renal function with proteinuria and hematuria. Further studies showed bilateral pleural effusions, positive antinuclear and antidouble-stranded DNA antibodies, lupus anticoagulant, and anticardiolipin B. C3 and C4 levels were low. SARS-Cov-2 PCR was positive after 2 negative tests. She also developed multiple deep venous thrombosis, in the setting of positive antiphospholipid antibodies and lupus anticoagulant. In terms of pathophysiology, COVID-19 is believed to cause a dysregulated cytokine response which could potentially be exacerbated by the shift in Th1 to Th2 response seen in SLE. Also, it is well documented that viral infections are an environmental factor that contributes to the development of autoimmunity; however, COVID-19 is a new entity, and it is not known if it could trigger autoimmune conditions. Additionally, it is possible that SARS-CoV-2, as it happens with other viruses, might lead to the formation of antiphospholipid antibodies, potentially contributing to the increased rates of thrombosis seen in COVID-19.
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Affiliation(s)
| | - Jasmin Hundal
- Internal Medicine Residency, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Dominique Feterman
- Internal Medicine Residency, University of Connecticut School of Medicine, Farmington, CT, USA
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Arvikar SL, Schoenfeld SR, Fox AS, Tanguturi VK, Stuart LD. Case 17-2019: A 44-Year-Old Man with Joint Pain, Weight Loss, and Chest Pain. N Engl J Med 2019; 380:2157-2167. [PMID: 31141639 DOI: 10.1056/nejmcpc1900419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Sheila L Arvikar
- From the Departments of Medicine (S.L.A., S.R.S., V.K.T.), Radiology (A.S.F.), and Pathology (L.D.S.), Massachusetts General Hospital, and the Departments of Medicine (S.L.A., S.R.S., V.K.T.), Radiology (A.S.F.), and Pathology (L.D.S.), Harvard Medical School - both in Boston
| | - Sara R Schoenfeld
- From the Departments of Medicine (S.L.A., S.R.S., V.K.T.), Radiology (A.S.F.), and Pathology (L.D.S.), Massachusetts General Hospital, and the Departments of Medicine (S.L.A., S.R.S., V.K.T.), Radiology (A.S.F.), and Pathology (L.D.S.), Harvard Medical School - both in Boston
| | - Andrew S Fox
- From the Departments of Medicine (S.L.A., S.R.S., V.K.T.), Radiology (A.S.F.), and Pathology (L.D.S.), Massachusetts General Hospital, and the Departments of Medicine (S.L.A., S.R.S., V.K.T.), Radiology (A.S.F.), and Pathology (L.D.S.), Harvard Medical School - both in Boston
| | - Varsha K Tanguturi
- From the Departments of Medicine (S.L.A., S.R.S., V.K.T.), Radiology (A.S.F.), and Pathology (L.D.S.), Massachusetts General Hospital, and the Departments of Medicine (S.L.A., S.R.S., V.K.T.), Radiology (A.S.F.), and Pathology (L.D.S.), Harvard Medical School - both in Boston
| | - Lena D Stuart
- From the Departments of Medicine (S.L.A., S.R.S., V.K.T.), Radiology (A.S.F.), and Pathology (L.D.S.), Massachusetts General Hospital, and the Departments of Medicine (S.L.A., S.R.S., V.K.T.), Radiology (A.S.F.), and Pathology (L.D.S.), Harvard Medical School - both in Boston
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Abstract
Pericarditis is a common cardiac manifestation in systemic lupus erythematosus (SLE). Serositis is recognized in the ACR, SLICC, and EULAR/ACR classification criteria. We reviewed the prior research regarding the epidemiology, risk factors, presentation, and treatment of pericarditis in SLE.
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Affiliation(s)
- Eric Dein
- Rheumatology, Johns Hopkins Bayview Medical Center, Baltimore, USA
| | | | - Michelle Petri
- Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Genevieve Law
- Rheumatology, FETCH (For Everything That's Community Health) South Island, Victoria, CAN
| | - Homa Timlin
- Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, USA
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13
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Lee HJ, Budhathoki R. Point-of-Care Ultrasound to Identify the Source of Dyspnea in a Patient With Systemic Lupus Erythematosus. Pediatr Emerg Care 2019; 35:243-244. [PMID: 30747789 DOI: 10.1097/pec.0000000000001761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Point-of-care ultrasound can be used to help identify the source of dyspnea in patients presenting to the emergency department. We present a case of an adolescent girl with a history of systemic lupus erythematosus presenting to the emergency department with chest pain and dyspnea and found to have both pleural and pericardial effusions on point-of-care ultrasound.
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Affiliation(s)
- Horton J Lee
- From the Pediatric Emergency Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York and Elmhurst Hospital, NYC Health + Hospitals, Elmhurst, NY
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14
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Abstract
RATIONALE Systemic lupus erythematosus (SLE) is a connective tissue disease that has many clinical manifestations. However, cardiac tamponade has been rarely reported especially as an initial presenting feature of systemic lupus erythematosus. Herein, we describe a case of cardiac tamponade as the first presentation of systemic lupus erythematosus in a male and presented the course of diagnosis and treatment of this patient. PATIENT CONCERNS A 32-year-old male patient developed a rapid progression of pericardial effusion and he was almost healthy in the past. Vital signs were significantly marked by high fever, tachycardia, and accelerated breathing rate of 37 times per minute. The ANA titer was 1:320 and anti-dsDNA was positive during his hospitalization. The complement levels were decreased but the ESR and the CRP level were increased obviously. Soon after, he appeared anemic and thrombocytopenic. DIAGNOSES The diagnosis of SLE was made based on the clinical and biochemical findings according to 2012 SLICC SLE Criteria. INTERVENTIONS The interventions included use CT-guided pericardial puncture to relieve symptoms in time; utilize high-dose glucocorticoids and immunosuppressants to therapy SLE; closely monitor the vital signs, blood routine, blood biochemical indicators, and volume of pericardial effusion. OUTCOMES After 2 months, the symptoms were disappeared almost completely and TTE showed his pericardial effusion had decreased significantly. LESSONS We should also keep SLE in mind when assessing male patients with pericardial effusions. Early examinations of sero-immunological markers and closely monitoring the performances are important for the diagnosis of the disease. Early pericardial puncture can quickly relieve symptoms and improve prognosis.
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15
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Khalid U, Favot M, Ubaid F. Pericardial Tamponade Masquerading as Abdominal Pain Diagnosed by Point-of-care Ultrasonography. Clin Pract Cases Emerg Med 2018; 1:403-406. [PMID: 29849367 PMCID: PMC5965226 DOI: 10.5811/cpcem.2017.9.34436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 09/01/2017] [Accepted: 09/22/2017] [Indexed: 11/11/2022] Open
Abstract
An 18-year-old female presented to the emergency department with a complaint of right-sided abdominal pain for one day. An abdominal computed tomography was significant for hepatic congestion and a large pericardial effusion. The patient was found to have early signs of cardiac tamponade on point-of-care ultrasonography. She was taken to the operating room for pericardial window and had immediate resolution of her symptoms. Patient was diagnosed with systemic lupus erythematosus based on laboratory and clinical findings. This case report details the atypical clinical features of our patient and highlights the subtle signs that should indicate the need for point-of-care cardiac ultrasonographic assessment in these patients.
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Affiliation(s)
- Usama Khalid
- Emory University, Department of Emergency Medicine, Atlanta, Georgia
| | - Mark Favot
- Wayne State University, Department of Emergency Medicine, Detroit, Michigan
| | - Farah Ubaid
- Wayne State University, Department of Emergency Medicine, Detroit, Michigan
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16
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Goswami RP, Sircar G, Ghosh A, Ghosh P. Cardiac tamponade in systemic lupus erythematosus. QJM 2018; 111:83-87. [PMID: 29048543 DOI: 10.1093/qjmed/hcx195] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cardiac tamponade is a rare but life-threatening complication of systemic lupus erythematosus (SLE). AIMS/OBJECTIVES To describe incidence, risk factors and treatment of cardiac tamponade in a large cohort of Indian patients with SLE. METHODS This retrospective study was conducted at the Department of Rheumatology, IPGMER, Kolkata, India from May 2014 to December 2016 on admitted patients with SLE. Lupus-related serositis was diagnosed after excluding other causes, such as infection, malignancy or heart failure. RESULTS Of 409 patients with SLE, pericarditis was diagnosed in 25.4% (104/409) and cardiac tamponade in 5.9% (24/409). Tamponade was the presenting feature of SLE in 50% (12/24). Tamponade occurred in 77.8% (14/18) of large effusions and in 11.63% (10/86) of small-to-moderate effusions. The commonest autoantibody in serum and pericardial fluid was anti-nucleosme antibody. Large pericardial effusion (>20 mm) (Odd's ratio (OR): 93.2, 95% confidence interval (CI): 11.1-782.5, P < 0.001) predicted tamponade. In the subset of patients with small-to-moderate sized pericardial effusion, tamponade was associated with pleuritis (OR: 44.5, 95% CI: 1.6-1243, P = 0.025), anti-nucleosome antibody (OR: 42.9, 95% CI: 1.6-1176, P = 0.026) and size of pericardial effusion (OR: 1.36, 95% CI: 1.04-1.76, P = 0.025). Repeated pericardiocentesis was required in 3 patients and one needed surgical intervention. Immunosuppressives used were: prednisolone with monthly intravenous cyclophosphamide (in 33.33%) and intravenous methylprednisolone with monthly cyclophosphamide (in 50%). CONCLUSIONS Pleuritis, anti-nucleosome antibody and size of pericardial effusion predicted development of tamponade. High dose immunosuppression (methylprednisolone and IV cyclophosphamide) alleviated need for surgery in majority.
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Affiliation(s)
- R P Goswami
- From the Department of Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata 700107, West Bengal, India
| | - G Sircar
- From the Department of Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata 700107, West Bengal, India
| | - A Ghosh
- From the Department of Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata 700107, West Bengal, India
| | - P Ghosh
- From the Department of Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata 700107, West Bengal, India
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17
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Castelli JB, Almeida G, Siciliano RF. Sudden death in infective endocarditis. AUTOPSY AND CASE REPORTS 2016; 6:17-22. [PMID: 27818954 PMCID: PMC5087979 DOI: 10.4322/acr.2016.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 08/23/2016] [Indexed: 11/23/2022] Open
Abstract
The case fatality rate of infective endocarditis (IE) is high and is associated with varying causes. Among them, acute myocardial infarction due to an embolism in a coronary artery is rare; the incidence of this complication in the setting of IE is reported to be up to 1.5%. We report a case of sudden death in a 22-year-old woman diagnosed with systemic lupus erythematosus who was referred to the Cardiology Center for the treatment of mitral valve incompetence due to IE. She was hemodynamically stable with antibiotic therapy and vasoactive drugs, despite severe mitral valve regurgitation. Unexpectedly, she presented cardiac arrest and died. The autopsy showed total occlusion of the left main coronary artery by septic embolus, which originated from the mitral vegetation, as the cause of death. Thus, although a rare complication, it should always be kept in mind that a coronary embolism can be a lethal complication of IE, and the possibility of surgical treatment combined with the underlying antibiotic therapy should be raised.
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Affiliation(s)
- Jussara Bianchi Castelli
- Anatomic Pathology Department - Instituto do Coração - Faculty of Medicine - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Germana Almeida
- Internal Medicine Department - Instituto do Coração - Faculty of Medicine - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Rinaldo Focaccia Siciliano
- Infectious Disease Control Department - Instituto do Coração - Faculty of Medicine - Universidade de São Paulo, São Paulo/SP - Brazil
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18
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19
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Weich HSVH, Burgess LJ, Reuter H, Brice EA, Doubell AF. Large pericardial effusions due to systemic lupus erythematosus: a report of eight cases. Lupus 2016; 14:450-7. [PMID: 16038109 DOI: 10.1191/0961203305lu2131oa] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of this study was to describe the clinical, echocardiographic and laboratory characteristics of large pericardial effusions and cardiac tamponade secondary to systemic lupus erythematosus (SLE). An ongoing prospective study was conducted at Tygerberg Academic Hospital, South Africa between 1996 and 2002. All patients older than 13 years presenting with large pericardial effusions (.10 mm) requiring pericardiocentesis were included. Eight cases (out of 258) were diagnosed with SLE. The mean (SD) age was 29.5 (10.7) years. Common clinical features were Raynaud’s phenomenon, arthralgia and lupus nephritis class III/IV. Echocardiography showed Libman-Sacks endocarditis (LSE) in all the mitral valves. Two patients developed transient left ventricular dysfunction; both these patients had pancarditis. Typical serological findings included antinuclear antibodies, anti-double stranded DNA antibodies, low complement C4 levels and low C3 levels. CRP was elevated in six cases. Treatment consisted of oral steroids and complete drainage of the pericardial effusions. No repeat pericardial effusions or constrictive pericarditis developed amongst the survivors (3.1 years follow up). This study concludes that large pericardial effusions due to SLE are rare, and associated with nephritis, LSE and myocardial dysfunction. Treatment with steroids and complete drainage is associated with a good cardiac outcome.
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Affiliation(s)
- H S v H Weich
- Cardiology Unit/TREAD Research, Tygerberg Hospital and Stellenbosch University, Parow, South Africa
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20
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Kuramochi Y, Kato T, Sudou M, Sugano H, Takagi H, Morita T. Cardiac tamponade due to systemic lupus erythematosus in patient with Prader-Willi syndrome after growth hormone therapy. Lupus 2016; 16:447-9. [PMID: 17664237 DOI: 10.1177/0961203307077995] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present a 16-year old girl with Prader-Willi syndrome who developed cardiac tamponade as an initial finding of systemic lupus erythematosus. Until one year prior to this episode, she had received growth hormone treatment for nine years. The association among Prader-Willi syndrome, growth hormone treatment and systemic lupus erythematosus is discussed. Lupus (2007) 16, 447—449.
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Affiliation(s)
- Y Kuramochi
- Department of Pediatrics, Shizuoka Medical Center, Shizuoka, Japan.
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21
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Peregud-Pogorzelska M, Kaźmierczak J, Kornacewicz-Jach Z. Heart Failure in Systemic Lupus Erythematosus Treated by Cardiac Resynchronization. Angiology 2016; 58:238-41. [PMID: 17495275 DOI: 10.1177/0003319707300369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The presented case report describes a female patient suffering from systemic lupus erythematosus, in whom dilated cardiomyopathy with progressive heart failure was a very first symptom of the disease. The advanced invasive treatment method, cardiac resynchronization therapy, was successfully applied to improve the quality of life, clinical symptoms, and exercise tolerance.
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22
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Maharaj SS, Chang SM. Cardiac tamponade as the initial presentation of systemic lupus erythematosus: a case report and review of the literature. Pediatr Rheumatol Online J 2015; 13:9. [PMID: 25802493 PMCID: PMC4369869 DOI: 10.1186/s12969-015-0005-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 03/07/2015] [Indexed: 11/10/2022] Open
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.
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Affiliation(s)
- Satish S Maharaj
- Eric Williams Medical Sciences Complex, The University of the West Indies, Champs Fleurs, Trinidad and Tobago
| | - Simone M Chang
- Eric Williams Medical Sciences Complex, The University of the West Indies, Champs Fleurs, Trinidad and Tobago
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23
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Chaudhari SS, Wankhedkar KP, Mushiyev S. SLE or hypothyroidism: who can triumph in cardiac tamponade? CASE REPORTS 2015; 2015:bcr-2014-206095. [DOI: 10.1136/bcr-2014-206095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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24
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Maharaj S, Chang S. Pericardial effusions in systemic lupus erythematosus — Who is most likely to develop tamponade? Int J Cardiol 2015; 180:149-50. [DOI: 10.1016/j.ijcard.2014.11.191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 11/23/2014] [Indexed: 11/25/2022]
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25
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Tian DG, Jacobs AK, Benjamin EJ. A 19-year-old female with tamponade and systemic lupus erythematosus (SLE). Int J Cardiol 2014; 179:1-2. [PMID: 25464389 DOI: 10.1016/j.ijcard.2014.10.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 10/20/2014] [Indexed: 11/28/2022]
Affiliation(s)
- David G Tian
- Cardiology Section, Department of Medicine, Boston University School of Medicine, Boston, MA, United States.
| | - Alice K Jacobs
- Cardiology Section, Department of Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Emelia J Benjamin
- Cardiology Section, Department of Medicine, Boston University School of Medicine, Boston, MA, United States; Preventive Medicine Section, Department of Medicine, Boston University School of Medicine, Boston, MA, United States
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26
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Abstract
The heart is one of the most frequently affected organs in SLE. Any part of the heart can be affected, including the pericardium, myocardium, coronary arteries, valves, and the conduction system. In addition to pericarditis and myocarditis, a high incidence of CAD has become increasingly recognized as a cause of mortality, especially in older adult patients and those with long-standing SLE. Many unanswered questions remain in terms of understanding the pathogenesis of cardiac manifestations of SLE. It is not currently possible to predict the patients who are at greatest risk for the various types of cardiac involvement. However, with the rapid advancement of basic science and translational research approaches, it is now becoming easier to identify specific mutations associated with SLE. A better understanding of these genetic factors may eventually allow clinicians to categorize and predict the patients who are at risk for specific cardiac manifestations of SLE.
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27
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Horai Y, Miyamura T, Takahama S, Sonomoto K, Nakamura M, Ando H, Minami R, Yamamoto M, Suematsu E. Influenza virus B-associated hemophagocytic syndrome and recurrent pericarditis in a patient with systemic lupus erythematosus. Mod Rheumatol 2014. [DOI: 10.3109/s10165-009-0241-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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28
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Ben Dhaou Hmaidi B, Boussema F, Aydi Z, Baili L, Rokbani L. [Cardiac tamponade as an initial manifestation of systemic lupus erythematosus]. REVUE DE PNEUMOLOGIE CLINIQUE 2012; 68:300-302. [PMID: 22766491 DOI: 10.1016/j.pneumo.2012.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 04/20/2012] [Accepted: 04/23/2012] [Indexed: 06/01/2023]
Abstract
Although pericarditis is the most frequent cardiac involvement in systemic lupus erythematosus (SLE), cardiac tamponade is very rare as an initial manifestation of this disease. We report the case of a 27-year-old patient in whom the diagnosis of SLE was discovered during cardiac tamponade.
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Affiliation(s)
- B Ben Dhaou Hmaidi
- Service de Médecine Interne, Faculté de Médecine de Tunis, Université de Tunis El Manar, Hôpital Habib Thameur, Tunis, Tunisie.
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29
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Life-Threatening Complications of Systemic Lupus Erythematosus. Autoimmune Dis 2011. [DOI: 10.1007/978-0-85729-358-9_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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30
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Papadimitraki ED, Isenberg DA. Childhood- and adult-onset lupus: an update of similarities and differences. Expert Rev Clin Immunol 2010; 5:391-403. [PMID: 20477036 DOI: 10.1586/eci.09.29] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Systemic lupus erythematosus (SLE) is a multifactorial autoimmune rheumatic disease. Although its highest prevalence is among women of childbearing age, the disease is not confined within this population. A total of 15-20% of cases of SLE are diagnosed in children younger than 16 years (childhood-onset lupus). Although there have been few studies directly comparing childhood- to adult-onset lupus, there is substantial evidence to suggest that pediatric lupus patients display some differences in their disease profile compared with adult-onset populations. Overall, an increased male-to-female ratio, a higher prevalence of nephritis and CNS involvement necessitating a more sustained need for steroids and immnosuppressive drugs, and a higher prevalence of progression to end-stage renal disease are distinguishing features of childhood-onset lupus. In contrast, a higher prevalence of pulmonary involvement, arthritis and discoid lupus are reported in adult-onset SLE patients. Furthermore, childhood-onset lupus patients may experience a serious negative impact on their psychosocial and physical development, issues that pose extra challenges to healthcare providers. Growth delay, osteoporosis, the psychological effect of steroid-induced alterations of the physical image, and often poor treatment compliance are the issues that need to be addressed in pediatric lupus populations. In this review, we compare the epidemiological, clinical and laboratory features, and treatment options of childhood- and adult-onset lupus, and comment on the applicability of the instruments that measure activity, severity and cumulative disease damage in childhood-onset disease. In addition, we highlight special issues of concern for pediatric lupus patients, discussing the significance in the transition from pediatric to adult rheumatology care.
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Affiliation(s)
- Eva D Papadimitraki
- Department of Rheumatology, 3rd floor, University College Hospital, 250 Euston Road, London NW1 2PG, UK
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31
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Kumar S, Iuga A, Jean R. Cardiac Tamponade in a Patient With Dengue Fever and Lupus Nephritis: A Case Report. J Intensive Care Med 2010; 25:175-8. [DOI: 10.1177/0885066609358955] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cases of small pericardial effusion have been reported in association with dengue fever (DF), largely with dengue hemorrhagic fever during epidemic outbreaks. However, cardiac tamponade developed by a patient with DF has not yet been reported in the English literature. We report a case of cardiac tamponade in a patient with DF and lupus nephritis. We describe the characteristic features to differentiate pericardial effusion of lupus origin from that of viral etiology. A 59-year-old Hispanic woman presented to the emergency department with complaints of 5 to 6 days of fever, myalgia, headache, and retro-orbital pain. Her symptoms started 3 days after returning from the Dominican Republic, where a dengue outbreak was reported. Her past medical history was significant for hypertension and lupus nephritis diagnosed 3 months earlier. On day 2, patient developed a large pericardial effusion that progressed to tamponade over the next 2 days, requiring surgical drainage. Subsequently, the patient improved; however, serological analysis did not suggest any lupus flare-up. Pericardial fluid analysis showed hypocellularity without lupus erythematosus cell and biopsy revealed only reactive mesothelial cells suggestive of viral etiology. Dengue serology was reported as markedly elevated, supporting a diagnosis of classic DF (both immunoglobulin M [IgM] titer 2.93 and IgG titer 12.13 by enzyme-linked immunosorbent assay [ELISA]; reference range: <0.90 for both). Absence of rise in serum antinuclear antibody (ANA) titer correlated with lack of inflammatory changes on the pericardium favored viral etiology over lupus origin. This differentiation is pertinent from a management perspective.
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Affiliation(s)
- Sunil Kumar
- Division of Internal Medicine, St. Luke's Roosevelt Hospital Center, University Hospital of Columbia University College of Physicians and Surgeons, NY, USA
| | - Alina Iuga
- Department of Pathology, St. Luke's Roosevelt Hospital Center, University Hospital of Columbia University College of Physicians and Surgeons, NY, USA
| | - Raymonde Jean
- Department of Pulmonary and Critical Care, St. Luke's Roosevelt Hospital Center, University Hospital of Columbia University College of Physicians and Surgeons, NY, USA,
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32
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Horai Y, Miyamura T, Takahama S, Sonomoto K, Nakamura M, Ando H, Minami R, Yamamoto M, Suematsu E. Influenza virus B-associated hemophagocytic syndrome and recurrent pericarditis in a patient with systemic lupus erythematosus. Mod Rheumatol 2009; 20:178-82. [PMID: 19898920 DOI: 10.1007/s10165-009-0241-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Accepted: 09/28/2009] [Indexed: 11/25/2022]
Abstract
We report a 24-year-old male with systemic lupus erythematosus (SLE) who developed influenza virus B-associated hemophagocytic syndrome and cardiac tamponade. Although the patient's general condition improved after steroid pulse therapy and pericardiocentesis, pericardial effusion re-accumulated. Colchicine and aspirin were administered, together with prednisolone, after which no further relapses occurred. This was a rare case of severe influenza-associated hemophagocytic syndrome and steroid-resistant pericardial effusion in an SLE patient.
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Affiliation(s)
- Yoshiro Horai
- Department of Internal Medicine and Rheumatology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka, 810-8563, Japan.
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33
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Rosenbaum E, Krebs E, Cohen M, Tiliakos A, Derk CT. The spectrum of clinical manifestations, outcome and treatment of pericardial tamponade in patients with systemic lupus erythematosus: a retrospective study and literature review. Lupus 2009; 18:608-12. [DOI: 10.1177/0961203308100659] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Pericardial effusions causing pericardial tamponade are rare in patients with systemic lupus erythematosus (SLE). The goal of this study is to describe in detail the clinical and laboratory characteristics of a group of patients with pericardial effusions and pericardial tamponade secondary to SLE. We retrospectively reviewed the records of 71 patients with SLE, admitted to our Hospital between 1985 and 2006 with a diagnosis of pericarditis, pericardial effusion and tamponade. Clinical features in the patients with tamponade were compared with those with pericardial effusions without tamponade. Pericardial effusion and SLE was confirmed in 41 patients. Pericardial tamponade occurred in nine of these patients (21.9%) at the time of presentation. All tamponade patients were women. Patients with pericardial effusions who developed tamponade had a statistically significant ( P = 0.05) lower C4 level as compared with patients who did not develop tamponade. A pericardial window was required in five patients even though the patients were receiving high-dose corticosteroids. In the present series, all patients with tamponade were treated with high-dose corticosteroids though five of nine patients required a pericardial window in contrast to previous studies. A low C4 level at presentation was predictive of the development of tamponade physiology.
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Affiliation(s)
- E Rosenbaum
- Division of Rheumatology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - E Krebs
- Division of Rheumatology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - M Cohen
- Division of Rheumatology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - A Tiliakos
- Division of Rheumatology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - CT Derk
- Division of Rheumatology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
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34
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Smiti M, Salem TB, Larbi T, Sfaxi AB, Ghorbel IB, Lamloum M, Houman MH. Péricardites lupiques : prévalence, caractéristiques cliniques et immunologiques. Presse Med 2009; 38:362-5. [DOI: 10.1016/j.lpm.2008.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Revised: 08/04/2008] [Accepted: 08/27/2008] [Indexed: 10/21/2022] Open
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35
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Herreros Ruiz-Valdepeñas B, Pintor Holguín E, Fariña García RM, Aranda Cosgaya C, Cano Carrizal R, de Casasola Sánchez GG. [Not Available]. REUMATOLOGIA CLINICA 2008; 4:212-214. [PMID: 21794533 DOI: 10.1016/s1699-258x(08)72467-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Accepted: 02/28/2008] [Indexed: 05/31/2023]
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36
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Khanfir MS, Ben Hafsa I, Neffati H, Ben Ghorbel I, Lamloum M, Houman MH. [Cardiac tamponade as an initial manifestation of systemic lupus erythematosus]. Presse Med 2008; 37:1244-6. [PMID: 18424061 DOI: 10.1016/j.lpm.2007.10.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Revised: 09/21/2007] [Accepted: 10/10/2007] [Indexed: 10/22/2022] Open
Affiliation(s)
- Monia Smiti Khanfir
- Service de médecine interne, Centre hospitalo-universitaire la Rabta et Unité de recherche 02/UR/08-15, Faculté de médecine, TN-1007 Tunis, Tunisie.
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37
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Loh Y, Oyama Y, Statkute L, Traynor A, Satkus J, Quigley K, Yaung K, Barr W, Bucha J, Gheorghiade M, Burt RK. Autologous hematopoietic stem cell transplantation in systemic lupus erythematosus patients with cardiac dysfunction: feasibility and reversibility of ventricular and valvular dysfunction with transplant-induced remission. Bone Marrow Transplant 2007; 40:47-53. [PMID: 17483845 DOI: 10.1038/sj.bmt.1705698] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Patients with cardiac dysfunction may be at increased risk of cardiac toxicity when undergoing hematopoietic stem cell transplantation (HSCT), which may preclude them from receiving this therapy. Cardiac dysfunction is, however, common in systemic lupus erythematosus (SLE) patients. While autologous HSCT (auto-HSCT) has been performed increasingly for SLE, its impact on cardiac function has not previously been evaluated. We, therefore, performed a retrospective analysis of SLE patients who had undergone auto-HSCT in our center to determine the prevalence of significant cardiac involvement, and the impact of transplantation on this. The records of 55 patients were reviewed, of which 13 were found to have abnormal cardiac findings on pre-transplant two-dimensional echocardiography or multi-gated acquisition scan: impaired left ventricular ejection fraction (LVEF) (n = 6), pulmonary hypertension (n = 5), mitral valve dysfunction (n = 3) and large pericardial effusion (n = 1). At a median follow-up of 24 months (8-105 months), there were no transplant-related or cardiac deaths. With transplant-induced disease remission, all patients with impaired LVEF remained stable or improved; while three with symptomatic mitral valve disease similarly improved. Elevated pulmonary pressures paralleled activity of underlying lupus. These data suggest that auto-HSCT is feasible in selected patients with lupus-related cardiac dysfunction, and with control of disease activity, may improve.
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Affiliation(s)
- Y Loh
- Division of Immunotherapy, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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38
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Pericardial Disease: Etiology, Pathophysiology, Clinical Recognition, and Treatment. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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39
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Gutiérrez-Macías A, Lizarralde-Palacios E, Cabeza-García S, Miguel-De la Villa F. Cardiac tamponade as the first manifestation of systemic lupus erythematosus in the elderly. Am J Med Sci 2006; 331:342-3. [PMID: 16775446 DOI: 10.1097/00000441-200606000-00012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although pericardial involvement is very frequent in systemic lupus erythematosus, cardiac tamponade is extremely rare as the first manifestation of the disease. On the other hand, systemic lupus erythematosus is a disease that predominantly affects young women, and it is a very uncommon condition in the elderly. We report a 91-year-old woman diagnosed with cardiac tamponade, which was the presenting clinical feature of a previously undiagnosed case of systemic lupus erythematosus.
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Nabibux MN, Dijkmans PA, Dijkmans BAC. A swinging heart as complication of systemic lupus erythematosus. Clin Rheumatol 2006; 26:825-6. [PMID: 16767351 DOI: 10.1007/s10067-006-0340-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2005] [Accepted: 12/16/2005] [Indexed: 11/27/2022]
Abstract
Cardiac involvement is very common in patients with systemic lupus erythematosus since 30 to 50% of all patients suffer from some sort of heart disease (Lahita, Textbook of rheumatology, 1997). Pericarditis is the most common form of involvement and occurs in 19 to 48% of patients (Lahita, Textbook of rheumatology, 1997). Pleural and/or pericardial pain can occur in any phase of the disease; however, pericardial effusion leading to cardiac tamponade is rare (Lahita, Textbook of rheumatology, 1997; Lee et al., Journal of Korean Medical Science 12(1):75-77, 1997). We report such a case, illustrated by echocardiography.
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Affiliation(s)
- Marita N Nabibux
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
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41
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Abstract
The objective of this study was to describe the prevalence and outcome of disease-related serositis in Chinese patients with systemic lupus erythematosus (SLE). The records of all SLE patients who attended the medical clinics of Tuen Mun Hospital, Hong Kong were retrospectively reviewed. Patients with disease-related serositis at any stage of their illness were identified and the outcome of these serositis episodes was reported. Three-hundred and ten patients (90% women) who fulfilled at least four of the ACR criteria for SLE were studied. The mean age of SLE onset was 32.6 +/- 13.1 years. sixty-nine episodes of SLE-related serositis occurred in 37 patients - 18 (26%) episodes were pericarditis/ pericardial effusion, 30 (44%) were pleuritis/pleural effusion and 21 (30%) were peritonitis/ascites. The prevalence of serositis was 12%. At the time of serositis, 34 (92%) patients had active SLE in other systems. Nonsteroidal anti-inflammatory drugs (NSAIDs) were initially used in 13 (35%) patients. Moderate to high doses of oral prednisolone was used in 28 (76%) patients for both serositis and concomitant disease activity in other organs. All episodes of serositis resolved completely within two months. Over a mean observation of 46 months, nine patients had 18 relapses of serositis, which were responsive to either NSAIDs or augmentation of prednisolone dosage. Pleural fibrosis developed in three patients. Serosal complications are not uncommon in patients with SLE and can be life-threatening. NSAIDs and corticosteroids are often effective but more aggressive immunosuppressive therapy is required for severe or refractory cases. The prognosis of lupus serositis is generally good. Relapse or progression to fibrotic disease is uncommon.
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Affiliation(s)
- B L Man
- Department of Medicine, Tuen Mun Hospital, Hong Kong SAR, China
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42
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Kumar MS, Smith M, Pischel KD. Case report and review of cardiac tamponade in mixed connective tissue disease. ACTA ACUST UNITED AC 2006; 55:826-30. [PMID: 17013845 DOI: 10.1002/art.22227] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Manisha S Kumar
- Scripps Clinic, Division of Rheumatology, La Jolla, CA 92037, USA.
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43
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Schotte H, Becker H, Domschke W, Gaubitz M. [Cardiovascular monitoring of patients with systemic lupus erythematosus]. Z Rheumatol 2005; 64:564-75. [PMID: 16328762 DOI: 10.1007/s00393-005-0668-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2004] [Accepted: 10/05/2004] [Indexed: 11/28/2022]
Abstract
Accelerated atherosclerotic cardiovascular disease is increasingly recognized as a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Cardiac manifestations of SLE are frequent and can involve almost all components of the heart. Pulmonary hypertension often develops during the course of SLE. The high incidence of cardiovascular complications may justify a screening of SLE patients in order to ensure early diagnosis and therapy. Results of diagnostic procedures that detect coronary insufficiency, surrogates of atherosclerotic burden and echocardiographic findings are often abnormal in SLE. However, evidence to support a routine screening for cardiovascular disease is currently not available. Therefore, based on the recommendations that have been proposed for other conditions associated with cardiovascular disease, we suggest assessment of risk factors and the performance of echocardiography at least annually in asymptomatic SLE patients. If two or more risk factors are present, an exercise ECG is recommended. The benefit, however, of screening SLE patients for cardiovascular disease has to be confirmed in prospective studies.
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Affiliation(s)
- H Schotte
- Medizinische Klinik und Poliklinik B, Universitätsklinikum Münster, Albert-Schweitzer-Str. 33, 48129 Münster, Germany.
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44
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Lange U, Strunk J. Kardiovaskul�re Manifestationen bei entz�ndlich-rheumatischen Erkrankungen. Z Rheumatol 2005; 64:12-7. [PMID: 15756495 DOI: 10.1007/s00393-005-0699-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2004] [Accepted: 12/17/2004] [Indexed: 10/25/2022]
Abstract
First descriptions about cardiovascular manifestations (mostly myocarditis and endocarditis) in inflammatory rheumatic diseases were dated at the end of the 19(th) century. Inflammatory rheumatic diseases show an increased cardiovascular manifestation and mortality, but the reasons for this are unknown. This overview presents the current knowledge about cardiovascular manifestations in different inflammatory rheumatic diseases for an efficient differential diagnostic and clarification in the daily practice.
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Affiliation(s)
- U Lange
- Kerckhoff-Klinik, Abteilung Rheumatologie, Sprudelhof 11, 61231, Bad Nauheim, Germany.
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45
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Yeh YH, Chu PH, Yeh CH, Wu YJJ, Lee MH, Jung SM, Kuo CT. Haemophilus influenzae pericarditis with tamponade as the initial presentation of systemic lupus erythematosus. Int J Clin Pract 2004; 58:1045-7. [PMID: 15605669 DOI: 10.1111/j.1742-1241.2004.00041.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Although cardiac tamponade is an important and emergent complication of systemic lupus erythematosus (SLE), purulent pericarditis is rare despite the high frequency of pericardial effusion in SLE. We describe the first SLE case of Haemophilus influenzae type-f pericarditis with cardiac tamponade with SLE as the initial presentation. The pathophysiology and therapy are discussed.
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Affiliation(s)
- Y-H Yeh
- Department of Internal Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan
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46
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Nardell EA, Fan D, Shepard JAO, Mark EJ. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 22-2004. A 30-year-old woman with a pericardial effusion. N Engl J Med 2004; 351:279-87. [PMID: 15254287 DOI: 10.1056/nejmcpc049014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Edward A Nardell
- Division of Pulmonary Medicine, Cambridge Hospital, Cambridge, Mass, USA
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47
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Abstract
Systemic lupus erythematosus (SLE) is a connective tissue disease characterized by the formation of autoantibodies and immune complexes. The heart and lungs are among the organ systems commonly affected in SLE. Pericarditis, premature coronary atherosclerosis, pleuritis and pulmonary infections are the most prevalent cardiopulmonary manifestations. Other rare associations include myocarditis, coronary arteritis, acute lupus pneumonitis/pulmonary haemorrhage, acute reversible hypoxaemia and 'shrinking lung' syndrome. Current imaging modalities may provide earlier detection of subclinical disease, which may aid in preventing these potentially fatal complications. The response to treatment varies, depending on the presentation of disease. In this chapter we address the frequency, diagnosis and monitoring, and treatment regimens of cardiac and pulmonary involvement in patients with SLE.
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Affiliation(s)
- Amy H Kao
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, PA 15261, USA
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48
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Abstract
Through direct signals to the nucleus mediated by the glucocorticoid receptor, exogenous glucocorticoids impact a broad array of cellular functions. DNA binding of the glucocorticoid receptor, depending upon the specific promoter to which the receptor binds, affects gene expression by recruiting transcription factors to the promoter or by interfering with the function of co-factors required for gene transcription. Steroid effects on the adhesion functions and release of products by phagocytic cells are prompt, occurring within hours of administration. Administration of corticosteroids results in rapid depletion of circulating T-cells due to a combination of effects including enhanced circulatory emigration, induction of apoptosis, inhibition of T-cell growth factors, and impaired release of cells from lymphoid tissues. Corticosteroid effects on B-cell function and immunoglobulin production are more delayed. The broad, generally suppressive effects of corticosteroids on the immune response render them useful for the management of most organ system manifestations of lupus. Corticosteroid toxicity in lupus is notable for greater susceptibility to infections, osteoporosis, osteonecrosis and accelerated atherogenesis. Although use of corticosteroids for patients with severe disease manifestations is associated with higher numbers of deaths from infections, overall survival appears to be improved.
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Affiliation(s)
- W W Chatham
- University of Alabama at Birmingham, Birmingham, Alabama, USA.
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49
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Oishi Y, Arai M, Kiraku J, Doi H, Uchiyama T, Hasegawa A, Kurabayashi M, Nagai R. Unclassified connective tissue disease presenting as cardiac tamponade: a case report. JAPANESE CIRCULATION JOURNAL 2000; 64:619-22. [PMID: 10952161 DOI: 10.1253/jcj.64.619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This report describes a case of cardiac tamponade as the initial manifestation of unclassified connective tissue disease (UCTD). A 68-year-old Japanese woman was admitted to hospital because of dyspnea and edema. She had undergone a radical left mastectomy for the treatment of breast cancer 18 years before. On admission, bilateral leg edema, hepatomegaly, and a paradoxical pulse were noted on physical examination. The erythrocyte sedimentation rate was elevated and the C-reactive protein was 2.8 mg/dl. Antinuclear antibodies and anti-SS-A/Ro antibodies were present. The scl-70 and anticentromere antibodies were elevated. Chest radiography showed cardiomegaly. Echocardiography revealed a large pericardial effusion, but the pericardial fluid did not contain malignant cells or bacteria. She did not meet the diagnostic criteria for any known connective tissue diseases, so was diagnosed with cardiac tamponade due to UCTD. Prednisolone (30 mg/day) was administered, which resulted in a gradual resolution of the pericardial effusion. Although connective tissue diseases are known to cause pericardial effusion, cardiac tamponade as the initial manifestation of the disease in the absence of other symptoms is quite rare.
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Affiliation(s)
- Y Oishi
- Second Department of Internal Medicine, Gunma University School of Medicine, Maebashi, Japan
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50
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Abstract
Systemic lupus erythematosus (SLE), a connective tissue disease characterized by the production of autoantibodies, can affect all organ systems. Cardiac involvement in patients with SLE has been described since the early 20th century. The manifestations are numerous and can involve all components of the heart, including the pericardium, conduction system, myocardium, valves, and coronary arteries. In recent years, echocardiography has yielded additional information about the heart in patients who have SLE with and without clinical cardiac involvement. Moreover, antiphospholipid antibodies have been linked to several cardiac manifestations in patients with SLE, including valvular abnormalities and possibly coronary artery disease. This updated, comprehensive review summarizes the new literature on SLE and the heart.
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Affiliation(s)
- K G Moder
- Division of Rheumatology and Internal Medicine, Mayo Clinic Rochester, MN 55905, USA
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