Cardiac Tamponade: An Unusual First Case Presentation of Systemic Lupus Erythematosus

This case is reported for the rarity of cardiac tamponade as a first manifestation of systemic lupus erythematosus (SLE). Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease with worldwide prevalence, affecting almost every organ in the body. A 27-year-old woman presented to our hospital after two months of progressive shortness of breath, generalized edematous syndrome and diffuse, non-migratory arthralgias; the patient's shortness of breath was exacerbated on exertion and associated with a vague sensation of chest tightness. Transthoracic echocardiography revealed a large circumferential pericardial effusion with an echo-free space of 34 mm in apical view and 36 mm in subcoastal view with an oscillating heart and diastolic collapse of the right ventricle and atrium. This case is reported for the rarity of cardiac tamponade as a first manifestation of SLE. Because pericarditis is more common in SLE patients, the low frequency of tamponade may be partially explained by the extensive use of non-steroidal anti-inflammatory medications (NSAIDs) and steroids, which effectively reduce pericardial inflammation. We emphasize the importance of including SLE in the differential diagnosis of patients presenting with cardiovascular symptoms, as cardiac tamponade and pleural effusion are uncommon early presentations of SLE. Early detection and diagnosis are essential for prompt intervention and better patient outcomes.