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LETTER TO EDITOR
Year : 1991  |  Volume : 57  |  Issue : 6  |  Page : 312-313

Cardiac tamponade in systemic lupus erythematosus




Correspondence Address:
P K Nigam


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How to cite this article:
Nigam P K, Sethi I M, Gupta S R. Cardiac tamponade in systemic lupus erythematosus. Indian J Dermatol Venereol Leprol 1991;57:312-3

How to cite this URL:
Nigam P K, Sethi I M, Gupta S R. Cardiac tamponade in systemic lupus erythematosus. Indian J Dermatol Venereol Leprol [serial online] 1991 [cited 2019 Jun 17];57:312-3. Available from: http://www.ijdvl.com/text.asp?1991/57/6/312/3720


To the Editor,

Cardiac involvement as the initial event in systemic lupus erythematosus (SLE) occurs in about 2% of the patients with pericarditis as the most frequent manifestation. [1] Cardiac tamponade is an unusual complication in SLE and until recently only 12 such cases had been reported .[2]

A 25-year-old female had slight breath­lessness on exertion, cough with scanty mu­coid expectoration, persistent moderate fever with chills and rigor, bodyache and pain in joints of one month duration. There were no complaints of burning micturition, loose mo­tions or convulsions. There was no past his­tory of tuberculosis, diabetes or hypertension.

Slight puffiness of face, lid oedema and pallor were present. She was febrile 1011F. A significant hair loss was present over both the temporal sites. Her wrist joints, knee joints and ankle joints were swollen and tender bi­laterally but their X-rays were normal. Examination of the chest showed a dull per­cussion note over the left supramammary re­gion and bilateral crepts and rhonchi, more over the supramammary, mammary and inframammary regions on right side and supramammary region on the left side. The cardiac dullness was enlarged and both the heart sounds were muffled. The liver was enlarged about 1.5 cm, firm and non tender, spleen was just palpable and slight free fluid was present. Shifting dullness was present. Examination of nervous system and fundus was normal.

The peripheral blood smear showed normocytic, hypochromic cells with no abnor­mal cells or immature cells of any series. The total leukocyte count was 6000/ml (P 62 L 32 M 4 E 2 ), packed cell volume 20%, reticu­locyte count 0.3% and ESR was 85 mm in . first hour. Platelet count was 1.8 lac/ml. Total serum proteins were decreased (3.8 gm per 100 ml) with decreased albumin : globulin ra­tio. Examination of urine showed RBC casts and albumin (++) but no sugar. VDRL and Mantoux tests were negative. LE cell test in the blood was absent while antinuclear factor (ANF) was present. X-Ray chest revealed massive consolidation of left lung, bilateral basal pleural effusion and enlarged cardiac shadow. In the electrocardiogram, there were sinus tachycardia, low voltage complexes in all the standard leads and features of antero-­inferoapical ischemia. Echocardiography showed a large pericardial effusion. Pericardiocentesis was performed using a subcostal approach and continuous ultrasound imaging. The examination of pericardial fluid showed numerous leukocytes, nearly all neu­trophils and no eosinophils, few RBC's, and sugar 60 mg/ml. LE cells were present in large numbers. Staining for acid fast bacilli was negative.

This patient demonstrates both an un­usual initial organ manifestation of SLE as well as a rare complication, the pericardial tamponade. The presence of non-erosive polyarteritis, temporal hair loss, pericarditis, raised ESR, positive ANF test, proteinuria,, and LE- cells in pericardial fluid permit the di­agnosis of SLE for this patient. An enlarged cardiac silhouette on the chest X-Ray, pres­ence of pericardial rub and low voltage ECG are,, suggestive of pericarditis. The echocardiography demonstrates pericardial fluid as evidence of pericarditis in upto 40% of cases. [3] The pericardial effusion secondary to pericarditis in SLE is usually small and very seldom leads to hemodynamic complications.

 
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1.Estes D and Christian CL : The natural history of systemic lupus erythematosus by prospective analysis, Medicine, 1971; 50 : 85-95.  Back to cited text no. 1    
2.Averbuch M, Bojko A and Levo Y : Cardiac tamponade in the early postpartum period as the presenting and predominant manifestaion of sys­temic lupus erythematosus, J Rheumatol, 1986; 13 : 444-445.  Back to cited text no. 2    
3.Maniscalo BS, Fether JM, McCans JL, et al Echocardiographic abnormalities in systemic lupus erythematosus, circulation, 1975; 52 : 211.  Back to cited text no. 3    




 

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