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Cardiac tamponade as the initial symptom due to systemic lupus erythematosus in a young man: A case report
Insights
Cardiac tamponade is a rare initial presentation of Systemic Lupus Erythematosus (SLE). This case highlights the importance of considering SLE in male patients with pericardial effusion, emphasizing early diagnosis and intervention for better outcomes.
Area of Science:
- Rheumatology
- Cardiology
- Internal Medicine
Background:
- Systemic Lupus Erythematosus (SLE) is a complex autoimmune disease with diverse clinical presentations.
- Cardiac tamponade, a serious cardiac complication, is infrequently reported as an initial manifestation of SLE, particularly in males.
Observation:
- A 32-year-old male presented with rapidly progressing pericardial effusion, fever, tachycardia, and tachypnea.
- Laboratory findings included a high ANA titer (1:320), positive anti-dsDNA, decreased complement levels, elevated ESR and CRP, anemia, and thrombocytopenia.
Findings:
- The patient was diagnosed with SLE based on the 2012 Systemic Lupus International Collaborating Clinics (SLICC) criteria.
- CT-guided pericardial puncture provided symptomatic relief, followed by treatment with high-dose glucocorticoids and immunosuppressants.
Implications:
- This case underscores the necessity of suspecting SLE in male patients presenting with pericardial effusion.
- Prompt serological marker evaluation and close monitoring are crucial for timely SLE diagnosis and management.
- Early pericardial intervention can significantly improve patient prognosis.
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.
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