A systemic lupus erythematosus patient with cardiac tamponade as a presenting symptom successfully treated with steroid pulse therapy

We report a SLE patient with cardiac tamponade as a presenting symptom, who was successfully treated with steroid pulse therapy. A 19-year-old girl was admitted to a hospital because of severe chest pain and dyspnea. She was well until one month before entry, when fever, anterior chest pain and polyarthritis developed. Antibiotics and predonisolon (40mg/day) were administered without benefit. She was refered to our hospital on Feb 17, 1987. On admission, active arthritis and malar rash were observed and large amount of pericardial effusion compressing cardiac output was demonstrated by echocardiography. Diagnosis of active SLE complicated with cardiac tamponade was made, and steroid pulse therapy was started. All of the above symptoms subsided within a week after pulse therapy, followed by amelioration of pericardial effusion as well as immunological paramaters. Although cardiac tamponade as a presenting symptom in SLE is rare, it may be fatal without correct diagnosis and prompt treatment. However, it has been reported that oral predonisolone alone sometimes fails to improve cardiac tamponade. Here, we describe a first case successfully treated with steroid therapy and discuss the therapeutic approach to SLE complicated by cardiac tamponade.