Cardiac tamponade: an uncommon presentation of hypertensive scleroderma renal crisis

Cardiac tamponade is an extremely rare manifestation of systemic sclerosis and has been reported to be a risk factor for the subsequent development of renal failure. We report the case of a 37-year-old man with recently diagnosed scleroderma who presented with chest pain and shortness of breath. He was found to have scleroderma renal crisis as well as cardiac tamponade. He responded hemodynamically to emergent pericardiocentesis and blood pressure control with angiotensin-converting enzyme inhibitors. However, the renal function deteriorated further leading to development of end-stage renal disease and required chronic hemodialysis.Although pericardial effusions are common in scleroderma, cardiac tamponade is rare. Coexistent hypertension and cardiac tamponade in scleroderma have not been described previously. Elevated systemic blood pressure can accompany and should not be used to exclude the diagnosis of cardiac tamponade. We emphasize the importance of pericardial disease as an uncommon but important cause of chest pain in patients with scleroderma.