Dados do Trabalho

Title

CARDIAC TAMPONADE AS INITIAL MANIFESTATION OF SYSTEMIC LUPUS ERYTHEMATOSUS: REPORT OF TWO CASES.

Background

Cardiac involvement in systemic lupus erythematosus (SLE) is common.
Pericardial involvement is the most common echocardiographic finding in patients with SLE.
Pericardial effusion occurs at some point in the evolution of the disease in more than half of the
patients.

Case report

Case 1: Previously healthy 13 years old female patient, under investigation for polyarthralgia,
myalgia, anemia and nephrotic proteinuria. A diagnosis of SLE was made after laboratory tests
revealed pancytopenia, positive ANA (1:640 mixed pattern: nuclear homogeneous + fine
speckled) and positive anti-dsDNA 1:160. During follow-up, the patient evolved with hypotension
and dyspnea. An echocardiogram was performed, revealing a large pericardial effusion with
signs of cardiac tamponade. She underwent emergency pericardiocentesis and pericardial
biopsy, which results were compatible with SLE.
Case 2: Female gender, 75 years old, previously hypertensive, in investigation for polyarthritis,
serositis and progressive dyspnea. Laboratory tests showed a positive ANA (1:640, mixed
pattern: nuclear homogeneous + fine speckled), anti-SSA (240) and anti-dsDNA (1:40).
Echocardiogram showed significant pericardial effusion with signs of cardiac tamponade. Urgent
pericardiocentesis with pericardial biopsy was performed. The biopsy and pericardial fluid
analysis results were consistent with SLE.

Conclusion

Although pericarditis and pericardial effusion are well described in patients with
SLE, cardiac tamponade is a rare manifestation reported in 1% of patients in several series. The
treatment consists of drainage of the pericardial fluid and high dose glucocorticoids.