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Federación Mexicana de Ginecología y Obstetricia, A.C.

2021, Number 12

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Ginecol Obstet Mex 2021; 89 (12)

Cardiac tamponade on a pregnant patient as the initial presentation of systemic lupus erythematosus. Case Report and literature review

Romero-Ohara LG, Alas-Pineda C, Morales RR, Domínguez-Aguilar DE, Hernández S, Mendoza C

Language: Spanish
References: 18
Page: 994-1001
PDF size: 333.57 Kb.


ABSTRACT

Background: Systemic lupus erythematosus (SLE) is a chronic, multisystemic disease of unknown etiology, whose clinical manifestations are heterogeneous. Pericardial involvement is the most common cardiac complication; however, the development of cardiac tamponade is rare, and even more so in pregnant patients presenting with SLE.
Objective: To present the clinical characteristics, diagnosis, treatment, and evolu- tion of cardiac tamponade in a pregnant patient that presents with systemic lupus erythematosus.
Clinical case: A 24-year-old patient, who is 27.5 weeks pregnant, presenting with anasarca, dyspnea that evolved to orthopnea and stabbing chest pain for three weeks. Her chest X-ray showed cardiomegaly grade II, congestive lung fields and pleural effusion at the level of cardiophrenic sinuses. The echocardiogram found a 500 mL pericardial effusion with evidence of cardiac tamponade. Progressive deterioration with compromised lung capacity, and the appearance of acute renal failure with progressive increases in creatinine; showing hemodynamic instability characterized by paradoxical pulse and hypotension. With positive Antinuclear Antibodies (ANA) and proteinuria, renal biopsy reports histopathological patterns corresponding to lupus nephritis, treated with steroid pulses and intravenous cyclophosphamide in a risk-benefit assessment, with subsequent satisfactory maternal-fetal evolution.
Conclusion: Cardiac tamponade is not common in patients with SLE, and it is even rarer as the initial manifestation, even more so during pregnancy. It is a clinical emergency and requires multidisciplinary management since pregnancy in a patient with SLE implies an increased risk of systemic complications.


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