SHM Converge Scientific Abstract ePoster Gallery-A Cardiac Conundrum: Pulmonary Hypertension in Systemic Lupus Erythematosus

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This case report describes a 28-year-old woman with no significant past medical history who presented with new dyspnea on exertion and tachycardia, raising concern for pulmonary hypertension and a large pericardial effusion. Her review of systems included fevers, dry cough, and intermittent hot, tingling sensations in her fingers. Initial evaluation showed anemia, thrombocytopenia, elevated BNP, and elevated LDH. Bedside echocardiography revealed a large pericardial effusion, elevated right-sided filling pressures, and right ventricular hypertrophy, prompting monitoring for tamponade and cardiology consultation.<br /><br />A broad differential for pulmonary hypertension was considered, including left heart disease, pulmonary embolism, chronic lung disease, and autoimmune disease. Right heart catheterization confirmed pulmonary hypertension with a mean pulmonary artery pressure of 44 and pulmonary vascular resistance of 4.2 Wood units. Rheumatologic testing was strongly positive, including ANA 1:2560, anti-dsDNA, anti-Smith, anti-Smith/RNP, SSA/Ro, and rheumatoid factor, along with low complement levels. Based on 2019 ACR/EULAR criteria, she met classification for systemic lupus erythematosus (SLE).<br /><br />She was treated with a prednisone taper and hydroxychloroquine for SLE, as well as sildenafil and furosemide for pulmonary hypertension. Her symptoms improved, and she was discharged with close follow-up by rheumatology and pulmonology.<br /><br />The report highlights that although pericarditis is a more common cardiac manifestation of SLE, pulmonary arterial hypertension can rarely be the initial presentation. Clinicians should consider SLE in patients with unexplained pulmonary hypertension and pericardial effusion, especially when other risk factors are absent, because early diagnosis and treatment may improve prognosis and reduce mortality.

Asset Subtitle

Corinne Allas

Meta Tag

Author List Brad R. Fiske, Corinne Allas, Jasmine Morante, Oscar E. Gallardo-Huizar, Preston Sitorus

Category Clinical Vignettes

Concept Systemic Lupus Erythematosus

Concept Pulmonary Hypertension

Concept Pericardial Effusion

Concept 2019 EULAR/ACR Classification Criteria

Concept Right Heart Catheterization

Distinguished Non-Finalist

Presenter Organization Charles R. Drew University/ UCLA David Geffen School of Medicine

Presenting Author Corinne Allas

Track Adult

Keywords

systemic lupus erythematosus

pulmonary hypertension

pericardial effusion

right heart catheterization

dyspnea on exertion

tachycardia

antinuclear antibody

anti-dsDNA

hydroxychloroquine

sildenafil

Systemic Lupus Erythematosus

Pulmonary Hypertension

Pericardial Effusion

2019 EULAR/ACR Classification Criteria

Right Heart Catheterization