Sub-acute Cardiac Tamponade as an Early Clinical Presentation of Childhood Systemic Lupus Erythematosus: A Case Report

Multimodality Cardiac Imaging in Patients with Systemic Lupus Erythematosus

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.

Juvenile lupus, cytomegalovirus infection and cardiac tamponade: case report

Objective:

To describe a rare case of cardiac tamponade in a pediatric patient with systemic lupus erythematosus (SLE) and cytomegalovirus (CMV) infection, and to discuss the relationship between these morbidities, the diagnostic approach, and the possible treatments.

Case description:

A 9-year-old girl presented to the emergency department with severe dyspnea, muffled heart sounds, jugular vein distention, hemodynamic instability, and intense pallor. She had previously been followed up at the outpatient clinic for a six-month history of mild respiratory distress, polyarthritis, fever, and various cutaneous manifestations. Doppler echocardiogram revealed pericardial effusion. The patient was submitted to pericardiocentesis followed by water seal pleuropericardial drainage, with no complications. The investigation continued, with fulfillment of clinical and laboratory SLE criteria plus CMV antigenemia of 15/200,000 cells. Medications to control CMV infection and SLE were then initiated, with good clinical and laboratory response.

Comments:

Pediatric SLE commonly manifests in a more severe form, accounting for high morbimortality. Cardiac tamponade could be one of the first manifestations of SLE, which can also be precipitated by infectious agents, such as CMV, leading to diagnostic confusion and misleading the treatment. Changes in therapeutics must also be considered in the presence of both conditions. This study presents a juvenile SLE case aggravated by a CMV infection with the unusual manifestation of cardiac tamponade.%

Cardiac Tamponade in an 18-year-old Male with Undiagnosed Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is a multisystem, autoimmune condition of extremely variable presentation and prognosis. While pericardial effusion is a common disease sequela, subsequent tamponade is a rare, potentially fatal complication. We present the case of an 18-year-old, previously healthy male who presented to the emergency department with a chief complaint of abdominal pain and hematochezia. Workup revealed massive pericardial effusion with tamponade pathophysiology requiring emergent pericardiocentesis, with further workup confirming a diagnosis of SLE. While SLE often presents in an indolent manner, cardiac tamponade may be the initial presentation of this disease.