Cardiac tamponade as the initial symptom due to systemic lupus erythematosus in a young man

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.

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

“…Studies have reported the average interval time from initial symptom onset to formal diagnosis ranging from six months to four years [6]. However, sparse reports of cardiac tamponade as the initial presentation of SLE have been reported [4, 7-13]. This current case differs from these previously cited cases, including patient sex and age, volume and rapidity of pericardial effusion, and subsequent development of tamponade development.…”

“…Our patient’s age of presentation is modestly outside the mean age range of both male symptom onset and diagnosis in SLE (26 - 38.4 years and 26 - 55 years, respectively), adding to the case’s novelty [14]. Only two of the reported cases above had affected patients of the male sex, and the ages of those male patients, 32 and 61 years of age, are significantly older than that of our patient [7, 13]. While even small volume pericardial effusions may lead to tamponade, there is a correlation of larger volumes being predictive of this sequela [15].…”

Cardiac Tamponade, an Unusual First Presentation of Systemic Lupus Erythematosus: A Case Report in a Rural Tertiary Hospital

“…The clinical manifestations of tamponade are brought on by a decrease in cardiac output and systemic venous congestion. Cardiac tamponade as the first sign of SLE is very rare and only limited to case reports and series [6,10,13,14]. Typical symptoms and signs include dyspnea, orthopnea, chest pain, pulsus paradoxus, jugular venous distension, and hypotension [3,7].…”

“…Cardiac involvement is common and can be found in more than half of SLE patients [3,4]. Although pericarditis and pericardial effusion are the most common cardiac manifestations, cardiac tamponade, especially as the initial manifestation of the disease, is extremely uncommon [5,6]. In this case report, we describe a 38-year-old Nigerian woman whose initial manifestation of SLE was cardiac tamponade.…”

Cardiac tamponade in a male as an initial presentation of SLE. An interesting case report

“…Nonsteroidal anti-inflammatory medicines (NSAIDs), corticosteroids, immunosuppressive medications, and biological agents may be used to treat lupus, depending on the symptoms, findings of blood tests, and the specific organs affected. With the right care, most lupus sufferers may anticipate a normal lifetime, but many may endure some degree of impairment [8]. More serious health issues associated with lupus, such neurological issues and kidney damage, need for aggressive therapy.…”