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Massive intractable pericardial effusion in a patient with systemic lupus erythematosus treated successfully with pericardial fenestration alone

Division of Rheumatology and Clinical Immunology, Jichi Medical University, Tochigi-ken, Japan

M Iwamoto

Division of Rheumatology and Clinical Immunology, Jichi Medical University, Tochigi-ken, Japan

Y Aoki

Division of Rheumatology and Clinical Immunology, Jichi Medical University, Tochigi-ken, Japan

Y Kishaba

Department of Pathology, Jichi Medical University, Tochigi-ken, Japan

T Nagashima

Division of Rheumatology and Clinical Immunology, Jichi Medical University, Tochigi-ken, Japan

H Nara

Division of Rheumatology and Clinical Immunology, Jichi Medical University, Tochigi-ken, Japan

T Kamimura

Division of Rheumatology and Clinical Immunology, Jichi Medical University, Tochigi-ken, Japan

A Tanaka

Department of Pathology, Jichi Medical University, Tochigi-ken, Japan

T Yoshio

Division of Rheumatology and Clinical Immunology, Jichi Medical University, Tochigi-ken, Japan

H Okazaki

Division of Rheumatology and Clinical Immunology, Jichi Medical University, Tochigi-ken, Japan

S Minota

Division of Rheumatology and Clinical Immunology, Jichi Medical University, Tochigi-ken, Japan sminota{at}jichi.ac.jp

Systemic lupus erythematosus (SLE) is often complicated by pericarditis with effusion, which generally responds well to glucocorticoid. We report herein a Japanese patient with SLE who showed a sign of cardiac tamponade and severe chest and back pain because of massive intractable pericardial effusion. Pulse glucocorticoid and pulse cyclophosphamide gained marginal effects. Pericardial effusion accumulated again soon after ultrasound-guided pericardiocentesis and drainage. Pericardial fenestration performed surgically as a last resort, for draining pericardial fluid into the pleural space, was very effective, and only a much smaller amount of fluid was observed in the space thereafter in comparison with the volume before the surgery. Pathological examination of the retrieved pericardium unfolded intense hyperplasia of small vessels and capillaries. Levels of IL-6 and TNF- in pericardial effusion were extremely higher than those in serum. Pericardial effusion with extensive capillary hyperplasia in SLE would be resistant to medical treatment and require surgical fenestration.

Key Words: cyclophosphamide • glucocorticoid • pericardial effusion • pericardial fenestration • pericarditis • systemic lupus erythematosus

Lupus, Vol. 17, No. 11, 1033-1035 (2008)
DOI: 10.1177/0961203308089437


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