Recurrent Pericarditis With Cardiac Tamponade in a Patient With Systemic Lupus Erythematosus: A Case Report

A 29-year-old male with a history of systemic lupus erythematosus (SLE) with class IV/V lupus nephritis, recurrent pericardial effusions, hypertension, and type 2 diabetes mellitus presented for worsening chest tightness and shortness of breath. Echocardiography revealed a large, free-flowing pericardial effusion circumferential to the heart, up to 2.9 cm at its widest diameter, with mild atrial and right ventricular collapse. Due to concern for tamponade, interventional cardiology was consulted, and a pericardiocentesis was performed, yielding 820 mL of serosanguinous fluid, and a pericardial drain was kept in place. Given his history of SLE, immunosuppressive therapy was started with intravenous methylprednisolone pulse dosing 250 mg twice a day for three days, followed by an oral prednisone taper and mycophenolate mofetil 500 mg twice a day titrating up to 1500 mg twice a day, as well as increasing hydroxychloroquine to 400 mg daily from 200 mg daily, starting colchicine 0.6 mg daily, and continuing voclosporin 23.7 mg twice a day. However, his pericardial effusion persisted, ultimately requiring a pericardial window. Unfortunately, just a few weeks later, he returned again with recurrent pleuropericarditis in spite of aggressive medical and surgical management and ultimately elected to leave against medical advice. This case highlights the challenges in managing recurrent pericardial effusions in patients with SLE.