Pericardial tamponade in pregnancy due to undiagnosed systemic lupus erythematosus: a case report

Pericardial tamponade during pregnancy is rare. Diagnosis of pericardial effusion can easily be made by echocardiography. Thorough clinical assessment, laboratory testing and advanced cardiac imaging are necessary to identify the underlying cause of pericardial effusion and rule out other causes of chest pain. Most diagnostic tests and therapeutic measures are safe during pregnancy. Systemic lupus erythematosus can be diagnosed by integrating clinical features and serologic testing. Certain autoantibodies increase the risk for adverse pregnancy events and multi-disciplinary team care is essential for a favourable pregnancy outcome.

A 37-year-old previously healthy woman presented with chest pain at 24 weeks gestational age. Echocardiography revealed a large pericardial effusion, which quickly progressed to pericardial tamponade. The woman required urgent thoracoscopic pericardial drainage as the gravid uterus impaired subcostal or apical access for pericardiocentesis. The surgery was performed without complications. Serologic testing was positive for antinuclear antibodies. Rheumatology assessment revealed further clinical features of systemic lupus erythematosus, which established the diagnosis. After initiation of treatment with hydroxychloroquine and prednisone the chest pain resolved and pericardial effusion did not recur. The twin fetuses were monitored regularly by the obstetrical team and no adverse pregnancy events occurred.

Cardiologists may be the first to detect pericardial effusion as a clinical feature of rheumatologic disease. Multi-disciplinary team care leads to good pregnancy outcomes for mother and child.