A 48-years-old Female with Stabbing Chest Pain and Pericardial Effusion: A Case Report

Author : A.K. Ratri*,M.Y. Alsagaff*, T.P. Asmarawati**
Upload Date : 19-04-2018

Background: Acute pericarditis is a common disease caused by inflammation of the pericardium; can occur as an isolated entity or as a manifestation of an underlying systemic disease, such as Systemic Lupus Erythematosus (SLE). Cardiovascular complications occur in more than 50% of SLE patients.

Case description: We report a clinical case of a 48 year old woman with abrupt shortness of breath and stabbing chest pain, with history of hypertension. She was dyspneic, febrile, palpitated. ECG showed sinus tachycardia, no ST-T changes. Lab studies revealed anemia (Hb 7.8), lymphopenia (12.1%), Salmonella typhi H +1/320, elevated Troponin at 0.11, leucocyturia (+3), proteinuria (+1) at urinalysis. Chest X-ray showed cardiomegaly CTR 60%, bilateral pleural effusions. Initial assessment was palpitation, anemia and typhoid fever. She got worse at day 2, pericardial friction rub was heard, and paroxysmal atrial fibrillation, diffuse concave ST elevations. Echocardiography revealed normal systolic LV function (EF by Teich 60%), but there were thickening pericardium along with moderate pericardial effusions. Thyroid function panel was normal, CRP was >20, and her ANA test result was positive. Ibuprofen and Colchicine were administered. She was consulted to an internist and received Methylprednisolone pulse dose for 3 days, then 62.5 mg/day, Cyclosporine, and Chloroquin. ST elevations returned to baseline 3 days after. Echo revealed no pericardial effusion after 9 days of treatment. She was discharged after resolved signs and symptoms at day 10 with close follow-up.

Discussion :The diagnosis of acute pericarditis is established  when a patient has at least two of the following symptoms or signs: chest pain consistent with pericarditis, pericardial friction rub, typical ECG changes, and a pericardial effusion of more than trivial size.

Conclusion Better understanding of clinical etiopathogenesis and management of SLE with pericarditis may overcome this complication with good prognosis.

KEYWORDS : acute lupus pericarditis, systemic lupus erythematosus

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