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Pericardial tamponade as the first manifestation of dermatopolymyositis
S Chraibi1, H Ibnabdeljalil, R Habbal
1Department of Cardiology, Hospital Center Ibn Rochd, Casablanca, Morocco.
Abstract:
Pericardial involvement in polymyositis and dermatomyositis (PM/DM) is rare, usually asymptomatic and exceptionally part of the initial presentation. We describe a 37-year-old patient hospitalized for overt acute pericarditis, revealing dermatomyositis, which to our knowledge has not been previously reported. Pericardial puncture relieved the patient. The pericardial fluid was citrine yellow, exsudative, and mainly contained lymphocytes. Search for LE cells and anti-DNA antibodies was negative, whereas the antinuclear antibodies and the rheumatoid factor were present in the pericardial fluid. A biopsy of the pericardium showed a non-specific chronic inflammatory state and the search for an etiology was negative. There was no sign of tuberculosis, systemic lupus, nor neoplasia. Moreover bacteriological cultures and HIV serology were negative. After pericardiostomy associated with corticosteroid therapy at the dose of 1 mg/kg/day, outcome was good with a resolution of the pericarditis confirmed at one-year follow-up. Since pericardial tamponade, even though rare, may be fatal in a patient with dermatomyositis, we emphasize that a two dimensional echocardiographic study should be performed in all patient presenting with dermatopolymyositis.
Insights
Pericarditis can be the initial presentation of dermatomyositis, a rare but serious condition. Early diagnosis and treatment, including echocardiography, are crucial for managing this autoimmune disease.
Area of Science:
- Rheumatology
- Cardiology
- Immunology
Background:
- Pericardial involvement in polymyositis and dermatomyositis (PM/DM) is uncommon.
- It is typically asymptomatic and rarely the initial presenting symptom.
Observation:
- A 37-year-old patient presented with acute pericarditis, later diagnosed with dermatomyositis.
- Pericardial fluid analysis revealed lymphocytic exudate with positive antinuclear antibodies and rheumatoid factor.
- Pericardial biopsy showed chronic inflammation; other causes were excluded.
Findings:
- This case represents a rare initial presentation of dermatomyositis.
- Pericardial effusion was successfully managed with pericardiostomy and corticosteroids.
- The patient showed good recovery with resolution of pericarditis at one-year follow-up.
Implications:
- Acute pericarditis can be the first sign of dermatomyositis.
- Echocardiography is recommended for all patients with dermatopolymyositis to detect potential pericardial involvement.
- Prompt diagnosis and management can prevent fatal complications like pericardial tamponade.