Impending Cardiac Tamponade as the Initial Manifestation of SLE

Abstract

Systemic lupus erythematosus (SLE) is an autoimmune disorder with protean manifestations. most commonly affecting women Cardiovascular manifestations are common but rare at initial presentation. Our patient presented with impending cardiac tamponade and was subsequently diagnosed with SLE. A 31-year-old female presented with fever, rash, and progressive exertional dyspnea. On examination, she had an elevated JVP and muffled heart sounds and features of pulmonary hypertension her baseline blood investigations showed acute kidney injury, albuminuria, and grossly elevated BNP. Chest radiography showed an enlarged cardiac silhouette and echocardiography showed large pericardial effusion with impending cardiac tamponade for which the patient underwent emergency pericardiocentesis. ANA profile confirmed our diagnosis of SLE with positive anti-dsDNA, anti-nucleosomes, anti-histones, anti-SSA, and anti-Jo 1. Being positive she was treated with pulse steroids and hydroxychloroquine. Renal biopsy was also done which showed class IV lupus nephritis. She improved clinically and was discharged with oral steroids, mycophenolate mofetil, and hydroxychloroquine. Cardiac tamponade is a life-threatening condition and SLE is an important differential to be considered during evaluation.

Keywords

• sle
• cardiac tamponade
• pericardiocentesis