[Pericarditis and pericardial effusion as the first presentation of systemic lupus erythematosus. Case report]

Rev Alerg Mex. Jan-Mar 2019;66(1):132-139. doi: 10.29262/ram.v66i1.528.
[Article in Spanish]

Abstract

Background: Acute pericarditis is rare in children; it can evolve to effusion or even cardiac tamponade. The main infectious agents are viruses and bacteria. The pharmacological treatment includes NSAIDs; just a few patients need pericardiocentesis.

Clinical case: A school-age patient was hospitalized because of chest pain; she was diagnosed with acute pericarditis and pericardial effusion, without any other symptoms. The disease pattern then evolved to dry cough, crushing epigastric abdominal pain, vomiting and fever. Due to a poor response to the initial treatment, immunological studies were requested. She tested positive to antinuclear antibodies (ANA), anti-double stranded DNA, direct Coombs and anticardiolipin antibodies; hypocomplementemia with lymphopenia was detected too, which is an indicative of systematic lupus erythematosus.

Conclusions: The torpid evolution or recurrence of pericarditis must direct toward excluding neoplastic or autoimmune bodies. Cardiovascular manifestations rarely appear initially in patients with systemic lupus erythematosus.

Antecedentes: La pericarditis aguda es poco frecuente en los niños; puede evolucionar a derrame o taponamiento cardiaco. Los principales agentes infecciosos son virus y bacterias. El tratamiento farmacológico es con antiinflamatorios no esteroideos; pocos pacientes requieren pericardiocentesis. Caso clínico: Paciente escolar hospitalizada por dolor torácico en zona precordial, quien fue diagnosticada con pericarditis aguda y derrame pericárdico, sin otra sintomatologia clínica. El cuadro progresó a tos seca, dolor abdominal epigástrico opresivo, vómitos gastroalimentarios y fiebre. Por mala respuesta al tratamiento inicial se solicitaron estudios inmunológicos. Se encontró positividad a los autoanticuerpos antinucleares, anti-ADN de doble cadena, Coombs directo y anticardiolipinas; también se encontró hipocomplementemia con linfopenia, indicativos de lupus eritematoso sistémico. Conclusiones: La evolución tórpida o recurrencia de la pericarditis debe orientar a descartar entidades neoplásicas o autoinmunes. Las manifestaciones cardiovasculares se presentan de forma inicial en pocos pacientes con lupus eritematoso sistémico.

Keywords: Pediatrics; Pericardial effusion; Pericarditis; Systemic lupus erythematosus.

Publication types

  • Case Reports

MeSH terms

  • Child
  • Female
  • Humans
  • Lupus Erythematosus, Systemic / complications
  • Lupus Erythematosus, Systemic / diagnosis*
  • Pericardial Effusion / etiology
  • Pericarditis / etiology