A second case of pericardial mesothelioma mimicking systemic lupus erythematosus in the literature in over 30 years: a case report

Abstract

BackgroundMesothelioma is a rare neoplasm which commonly develops in the pleura of people exposed to asbestos. Pericardial mesothelioma accounts for only 0.7 % of all malignant mesotheliomas and it usually presents with pericardial effusion, mimicking serositis. To date, there are approximately 200 cases of pericardial mesothelioma described in the medical literature, and little knowledge exists about the systemic manifestations of this pathology. The first and only described case of pericardial mesothelioma with autoimmune features dates back to 1984 and, in our case report, we describe the second. Case presentationWe report a case of a 45-year-old white woman whose pericardial mesothelioma was initially misdiagnosed as pericardial involvement of an autoimmune disease (systemic lupus erythematosus). After several relapses of pericardial effusion, a computed tomography scan and a biopsy with histological analysis were performed revealing neoplastic growth. ConclusionsWe describe a rare case of pericardial mesothelioma in a patient with a clinical presentation compatible with lupus serositis. Clinicians should consider malignant mesothelioma in the differential diagnosis of pericardial effusion, especially when it is recurrent and not clearly explained by other causes. Cytological samples should always be obtained and, if imaging tools are suggestive for solid processes, histological confirmation is mandatory.

Pericardial Tumor, a Rare Manifestation of Sjogren’s Syndrome Secondary to Systemic Lupus Erythematosus

“…Other malignant tumors may include sarcomas, lymphomas, and primitive neuroectodermal tumors. One such case study presented mesothelioma of the pericardium with suggestive autoimmune features mimicking lupus [1].…”

“…Malignant neoplasms include sarcomas, lymphomas, primitive neuroendocrine tumors, and mesotheliomas, being the most common malignant pericardial neoplasm. The first case of pericardial mesothelioma with autoimmune features dates back to 1984 [1]. A total of 150 cases of primary mesothelioma of the pericardium have been reported to date [2].…”

A Rare Case of Malignant Mesothelioma Presenting with Systemic Lupus Erythematosus Seropositivity: A Case Report and Review of Literature

“…malignant mesothelioma may present with systemic autoimmune features, thus complicating its diagnosis. It is important to keep in mind that recurrent effusions without obvious etiologies should prompt additional investigation beyond rheumatologic conditions and into potential neoplasms [2].…”

“…SLE is most commonly diagnosed in young, African American females aged 16-55. Incidence rates of SLE in the USA are 20-150 new cases per 10,000 each year [2]. Associations between malignancies and rheumatologic seropositivity have been studied, including the potential influence of occupational exposures; however, little is known about how and why.…”

A 75 year old male with recurrent unilateral pleural effusion and positive ANA

“…Autoimmune syndromes associated with mesothelioma have been numerous in the literature, including stiff-person syndrome [15], polyneuropathy [16], leukocytoclastic vasculitis [17], among others. There are at least two published cases of SLE-associated pericardial mesothelioma [18,19]. Interestingly, prior asbestos exposure has been linked with systemic autoimmune disease including systemic sclerosis, rheumatoid arthritis, and SLE [14].…”