Pericardial tamponade secondary to sudden steroid withdrawal in chronic rheumatoid arthritis

A patient with chronic rheumatoid arthritis was admitted to the hospital with cervical fracture. Two weeks after acute steroid withdrawal, she was noted to have pleural effusion, and signs and symptoms of acute pericardial tamponade. An open partial pericardiectomy and drainage relieved the symptoms. The sequence of events suggests that rapid steroid withdrawal might have precipitated rapid accumulation of pleural and pericardial fluid.