Acute Pericarditis: An Isolated Initial Manifestation of Systemic Lupus Erythematosus (SLE)

Pericarditis is an inflammation of the pericardium that may arise from multiple etiologies, including autoimmune diseases such as systemic lupus erythematosus (SLE). Although cardiovascular involvement is relatively common in established SLE, acute pericarditis as an isolated and initial manifestation is rare and can delay diagnosis. Constrictive pericarditis, although an uncommon feature of lupus, has been rarely reported as an initial presentation without prior recurrent episodes of acute pericarditis, further underscoring the heterogeneity of pericardial involvement in SLE. We present the case of a 23-year-old male with no significant past medical history who arrived at the ED with acute precordial chest pain radiating to the neck and back, exacerbated by leaning forward, and accompanied by tachycardia, dyspnea, and fever. On admission, the ECG demonstrated ST-segment elevation in leads V2-V5 and first-degree atrioventricular block, while inflammatory markers were elevated with normal troponin levels. A pericardial friction rub was noted on physical examination, and cardiac MRI showed evidence of acute pericardial inflammation. During hospitalization, acute kidney injury of suspected primary renal origin prompted autoimmune testing, which revealed high-titer antinuclear antibodies, positive anti-dsDNA and anti-SSA antibodies, and hypocomplementemia, confirming the diagnosis of SLE. The patient was initially managed with nonsteroidal anti-inflammatory drugs and colchicine and subsequently treated with prednisone, mycophenolate mofetil, and hydroxychloroquine, achieving clinical improvement and stabilization without recurrence of symptoms. This case illustrates the importance of considering autoimmune etiologies in young patients presenting with idiopathic pericarditis. Early identification of SLE in such atypical presentations allows timely initiation of immunosuppressive therapy, reduces the risk of severe complications such as lupus nephritis or cardiac tamponade, and highlights the value of a multidisciplinary approach to improve prognosis.