SHM Converge Scientific Abstract ePoster Gallery-Cardiac Tamponade as a First Presentation of Systemic Lupus Erythematous

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This case describes a 22-year-old man whose first presentation of systemic lupus erythematosus (SLE) was cardiac tamponade, a rare and potentially life-threatening complication. He arrived with one week of fever, worsening shortness of breath, poor appetite, and headache, along with a month of polyarticular joint swelling. In the emergency department, he was hypoxic and tachycardic, and exam findings suggested poor perfusion and respiratory distress.<br /><br />Imaging showed an enlarged cardiac silhouette and a moderate pericardial effusion, with associated pleural effusions. Because of concern for tamponade, he underwent urgent pericardiocentesis, which removed about 1 liter of serosanguinous fluid. Cultures and cytology were negative for infection or malignancy. Further testing revealed a strongly positive ANA, elevated anti-dsDNA antibodies, and low complement levels, supporting a diagnosis of SLE.<br /><br />His hospitalization was complicated by acute kidney injury with hematuria and proteinuria. Kidney biopsy showed class IV diffuse proliferative lupus nephritis. He was treated with intravenous steroids and mycophenolic acid, leading to improvement in renal function. He was discharged with rheumatology follow-up for newly diagnosed SLE.<br /><br />The case highlights that although pericarditis and pericardial effusion are known manifestations of SLE, cardiac tamponade is an uncommon initial presentation, especially in young patients. Clinicians should maintain a broad differential diagnosis when evaluating acute dyspnea and tamponade physiology, as early recognition of SLE allows prompt initiation of immunosuppressive therapy and may help prevent additional organ damage.

Asset Subtitle

Simin Hossain

Meta Tag

Author List Angie Molina, Dara Farber, Katelyn E. Donohue, Simin Hossain

Category Clinical Vignettes

Concept Cardiac Tamponade

Concept Systemic Lupus Erythematosus

Concept Pericardial Effusion

Concept Lupus Nephritis

Concept Echocardiography

Distinguished Non-Finalist

Presenter Organization University of Maryland

Presenting Author Simin Hossain

Track Adult

Keywords

systemic lupus erythematosus

cardiac tamponade

pericardial effusion

pericardiocentesis

young adult

anti-dsDNA antibodies

low complement

lupus nephritis

class IV diffuse proliferative

immunosuppressive therapy

Cardiac Tamponade

Systemic Lupus Erythematosus

Pericardial Effusion

Lupus Nephritis

Echocardiography