Sami Faria, Sami Shahzad Ahmed, Tanveer Saman, Sami Hania
Internal Medicine, Allama Iqbal Medical College, Lahore, PAK.
Internal Medicine, Trinity Health Oakland Hospital, Pontiac, USA.
Cureus. 2023 Jun 4;15(6):e39947. doi: 10.7759/cureus.39947. eCollection 2023 Jun.
Cardiac tamponade is an uncommon complication of systemic sclerosis (SSc) with a high mortality rate. Here, we report a case of a 58-year-old patient with limited cutaneous systemic sclerosis (lcSSc), gastroesophageal reflux disease (GERD), diabetes mellitus, pulmonary hypertension (PHTN), and COVID-19 infection, which occurred one month ago, presenting with a large hemorrhagic pericardial effusion and early cardiac tamponade. The patient had an acute onset of progressive dyspnea and anasarca. On examination, she was tachypneic, tachycardic, desaturating on room air, and hypotensive. Pitting edema up to thighs and bilateral basilar crackles were also appreciated. Labs were remarkable for negative troponin, chest X-ray with pulmonary congestion, D-dimer at 6.01, CT angiogram negative, brain natriuretic peptide level at 73 pg/mL, C-reactive protein level at 7.64 mg/dL, normal complement levels, and negative COVID-19 test results. Echocardiography showed early tamponade and a large circumferential effusion with chamber collapse. Right heart catheterization was performed finding PHTN at 54 mmHg. Pericardiocentesis drained 500 mL of the hemorrhagic effusion. Fluid analysis showed RBC at 220,000/uL, WBC at 5000/uL, protein 4.8 g/dL, lactate dehydrogenase level of 1275 U/L, and negative cytology. The patient was treated for serositis from lcSSc flare with mycophenolate mofetil and steroids, and responded very well. Hemorrhagic cardiac tamponade is a very rare phenomenon in limited scleroderma. A recent COVID-19 infection could have served as a trigger factor for our patient's lcSSc in long remission to flare up. Clinicians should maintain a high index of suspicion and a low threshold for intervention when lcSSc patients have an acute onset of cardiac compromise, especially with a history of a recent COVID-19 infection.
心脏压塞是系统性硬化症（SSc）的一种罕见并发症，死亡率很高。在此，我们报告一例58岁患者，患有局限性皮肤系统性硬化症（lcSSc）、胃食管反流病（GERD）、糖尿病、肺动脉高压（PHTN），且一个月前感染了新冠病毒（COVID-19），表现为大量出血性心包积液和早期心脏压塞。患者急性起病，出现进行性呼吸困难和全身水肿。检查发现，她呼吸急促、心动过速，在室内空气中血氧饱和度下降，且血压降低。还可观察到大腿以下凹陷性水肿和双侧肺底湿啰音。实验室检查显示肌钙蛋白阴性、胸部X线显示肺淤血、D-二聚体为6.01、CT血管造影阴性、脑钠肽水平为73 pg/mL、C反应蛋白水平为7.64 mg/dL、补体水平正常、新冠病毒检测结果为阴性。超声心动图显示早期心脏压塞和大量环形积液伴心腔塌陷。右心导管检查发现肺动脉高压，压力为54 mmHg。心包穿刺抽出500 mL出血性积液。液体分析显示红细胞为220,000/uL、白细胞为5000/uL、蛋白4.8 g/dL、乳酸脱氢酶水平为1275 U/L，细胞学检查为阴性。患者因lcSSc病情活动引发的浆膜炎接受霉酚酸酯和类固醇治疗，反应良好。出血性心脏压塞在局限性硬皮病中是一种非常罕见的现象。近期的新冠病毒感染可能是我们这位处于长期缓解期的患者lcSSc病情复发的触发因素。当lcSSc患者急性出现心脏功能损害，尤其是有近期新冠病毒感染史时，临床医生应保持高度怀疑并降低干预阈值。
