Department of Medicine, Division of Rheumatology, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
University Hospitals, Cleveland Medical Center, Cleveland, OH, USA.
Am J Case Rep. 2022 Jul 10;23:e936273. doi: 10.12659/AJCR.936273.
BACKGROUND Systemic lupus erythematosus (SLE) is a common autoimmune disorder in women of childbearing age. It can present during pregnancy and may lead to poor maternal and fetal outcomes with a higher risk of preterm birth and pre-eclampsia. Women are at a higher risk of lupus flares during pregnancy, especially if undiagnosed or disease is poorly controlled. Cardiac tamponade is a rare complication of SLE and can be fatal. CASE REPORT A 21-year-old primigravida African-American female with a history of asthma presented with progressive pleuritic left shoulder pain. She had a recent history of sore throat, facial rash, and depressed mood after sun exposure. Work-up was strongly positive for antinuclear antigen, anti-smith, anti-smith/ribonucleoprotein, anti-chromatin, anti-SSA, anti-SSB, anti-dsDNA, and low C3. Echocardiogram showed hemodynamically stable cardiac tamponade. Patient also had proteinuria and hypertension attributed to pre-eclampsia. However, a renal biopsy confirmed lupus nephritis. The patient was treated with pericardiocentesis, prednisone, azathioprine, and hydroxychloroquine. There was significant clinical improvement with resolution of cardiac tamponade and improvement in renal function. CONCLUSIONS Cardiac tamponade is a rare and life-threatening manifestation of SLE. Prompt work-up and treatment with immunosuppressants and pericardiocentesis is needed to improve maternal and fetal outcomes. SLE patients are at a higher likelihood of exacerbations of the disease during pregnancy. It also important to rule out lupus nephritis in an SLE patient with pre-eclampsia. This report has shown the importance of accurate diagnosis of SLE in pregnancy and the appropriate management to ensure the best outcomes for the mother and fetus.
系统性红斑狼疮（SLE）是育龄期女性常见的自身免疫性疾病。它可在妊娠期间出现，并可导致母婴结局不佳，早产和子痫前期的风险增加。女性在怀孕期间狼疮发作的风险更高，尤其是在未确诊或疾病控制不佳的情况下。心脏压塞是 SLE 的罕见并发症，可致命。
一位 21 岁的初产妇非裔美国女性，有哮喘病史，表现为进行性左侧胸痛伴肩痛。她最近有咽痛、面部皮疹和日晒后情绪低落。检查强烈提示抗核抗体、抗-Smith、抗-Smith/核糖核蛋白、抗染色质、抗-SSA、抗-SSB、抗双链 DNA 和 C3 降低。超声心动图显示为血流动力学稳定的心脏压塞。患者还存在蛋白尿和高血压，归因于子痫前期。然而，肾活检证实为狼疮肾炎。患者接受了心包穿刺术、泼尼松、硫唑嘌呤和羟氯喹治疗。心包穿刺术、免疫抑制剂治疗后，患者的临床症状显著改善，心脏压塞得到缓解，肾功能得到改善。
心脏压塞是 SLE 的一种罕见且危及生命的表现。需要及时进行检查和治疗，以改善母婴结局。SLE 患者在怀孕期间更有可能出现疾病恶化。对于伴有子痫前期的 SLE 患者，还需要排除狼疮肾炎。本报告表明，在怀孕期间准确诊断 SLE 并进行适当的管理对于确保母婴的最佳结局非常重要。
