Abstract
Systemic lupus erythematosus (SLE) is an autoimmune connective tissue disorder with multiple system involvements whichcommonly affects the cardiovascular system. Although pericarditis and pericardial effusion are prevalent cardiac manifestationsin SLE, massive pericardial effusion as an initial presentation is unusual. We describe a 47-year-old woman who presented tothe hospital with a headache, dry cough, shortness of breath, and fatigue. According to the clinical, radiologic, echocardiographicand laboratory rheumatologic test findings, SLE was diagnosed and treatment with prednisolone, hydroxychloroquine, andmycophenolate mofetil was initiated. The patient improved clinically, and follow-up echocardiography showed a reduction inthe effusion volume compared with previous tests within the preceding 6 months. In patients with cardiopulmonary symptoms,especially when other organ involvement is seen, screening for autoimmune systemic diseases such as SLE should beconsidered. To achieve rapid recovery and prevent life-threatening complications, early diagnosis and treatment are essential.
Highlights
Systemic lupus erythematosus (SLE) is an autoimmune connective tissue disorder with multiple system involvement which commonly affects the cardiovascular system [1]
In this report we describe a 47-year-old Iranian woman who presented to the emergency department with massive pericardial effusion
Cardiac involvement is rarely detected as an initial presenting feature in SLE, and pericardial effusion is usually mild, small, and insignificant in SLE patients; massive symptomatic pericardial effusion and cardiac tamponade, are possible as initial presentations in this disease [2]
Summary
Systemic lupus erythematosus (SLE) is an autoimmune connective tissue disorder with multiple system involvement which commonly affects the cardiovascular system [1]. The patient was conscious and oriented with a good general condition and no respiratory distress She had a hypertensive crisis (blood pressure =170/110), tachycardia (pulse rate = 110), tachypnea (respiratory rate = 25), low-grade fever (body temperature = 37.8 oral). The patient was transferred to the intensive care unit (ICU) for close monitoring Because of her pancytopenia, a peripheral blood smear (PBS) was requested, and the results indicated enlarged platelets and anisocytosis with an approximate platelet count = 140,000/microliter, erythrocyte hypochromia and anisopoikilocytosis. A peripheral blood smear (PBS) was requested, and the results indicated enlarged platelets and anisocytosis with an approximate platelet count = 140,000/microliter, erythrocyte hypochromia and anisopoikilocytosis It was polymorphonuclear leukocytes (PMN) dominant, and no atypical cell was seen. Fluorescent antinuclear antibody(ANA) (speckled pattern) Anti-double stranded DNA antibody Anti-Ro antibodies
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