Calcified constrictive pericarditis resulting in tamponade in a patient with systemic lupus erythematosus
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Rheumatology International https://doi.org/10.1007/s00296-020-04747-6
INTERNATIONAL
CASE BASED REVIEW
Calcified constrictive pericarditis resulting in tamponade in a patient with systemic lupus erythematosus Antigone Pieta1 · Eleftherios Pelechas1 · Nafsika Gerolymatou1 · Paraskevi V. Voulgari1 · Alexandros A. Drosos1 Received: 13 September 2020 / Accepted: 31 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with multiorgan involvement, including heart. Pericarditis—the most common cardiac manifestation—occurs in up to 50% of cases, resulting in positive treatment outcomes. Rarely, it evolves to hazardous complications. A 50-year-old woman with SLE in clinical remission, receiving hydroxychloroquine 400 mg/day, presented to us with severe chest pain and low-grade fever. Physical examination revealed a friction rub and decreased breath sounds at the right lung base. Laboratory evaluation demonstrated leukopenia, thrombocytopenia, low C4 levels, and high acute phase reactants. Chest X-ray exhibited cardiomegaly, calcified pericardium, and right pleural effusion, confirmed by CT scan. PPD skin test and IGRA were both negative. Pericardial fluid, blood, and urine cultures for bacteria and fungi, as well as Gram and Ziehl-Neelsen stains were negative. Serological tests for viruses were also negative. The patient was diagnosed with calcified constrictive pericarditis (CP) due to SLE. She was treated with cyclophosphamide and methylprednisolone pulses, without improvement. Her clinical condition deteriorated, developing signs and symptoms compatible with cardiac tamponade (TMP), which was confirmed by Doppler echocardiography. The patient underwent pericardiectomy. A dramatic response was noted and she was discharged with prednisone 50 mg/day and azathioprine 100 mg/day. Thus, we review and discuss the relevant literature of SLE cases with CP or TMP. When an SLE patient presents with CP, infectious causes should be excluded first. To the best of our knowledge, this is the only case of SLE and calcified CP leading to TMP, hence physicians should be aware of this complication. Keywords Calcified pericarditis · Cardiac manifestations · Cardiac tamponade · Constrictive pericarditis · SLE
Introduction
* Alexandros A. Drosos [email protected] http://www.rheumatology.gr Antigone Pieta [email protected] Eleftherios Pelechas [email protected] Nafsika Gerolymatou [email protected] Paraskevi V. Voulgari [email protected] 1
Rheumatology Clinic, Department of Internal Medicine, School of Health Sciences, University Hospital of Ioannina, University of Ioannina, 45110 Ioannina, Greece
Systemic lupus erythematosus (SLE) is a chronic, systemic, autoimmune disease affecting mainly women of childbearing age. The course of the disease is unpredictable, accompanied by mild to life-threatening complications, depending on the organ or system involved. The most common clinical features concern the cutaneous and musculos
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