Massive Pericardial Effusion in Young Woman as Initial Presentation of Systemic Lupus Erythematosus

Abstract

Life-threatening cardiovascular compromise may occur when extensive pericardial effusion represents the initial manifestation of an underlying autoimmune disorder such as systemic lupus erythematosus. An 18-year-old woman presented with worsening dyspnea, palpitations, and peripheral edema. Physical examination revealed tachycardia and muffled heart sounds. Laboratory evaluation demonstrated anemia, leukopenia, thrombocytopenia, elevated creatinine levels, and significant proteinuria. Electrocardiography showed low-voltage QRS complexes, while chest radiography revealed a characteristic “water bottle” cardiac silhouette. Transthoracic echocardiography confirmed massive pericardial effusion with right atrial systolic collapse and marked respiratory variation in tricuspid inflow, indicating hemodynamic significance. The diagnosis was established by a positive antinuclear antibody test and an EULAR/ACR classification score of 13. Treatment with anti-inflammatory agents, immunosuppressive therapy, and supportive cardiovascular management resulted in clinical improvement, and the patient was discharged after five days. This case underscores the importance of considering autoimmune etiologies in young patients presenting with unexplained massive pericardial effusion.