A 30-year-old woman with symmetric polyarthritis of small and medium size managed with 6 months of evolution, treated as rheumatoid arthritis with methotrexate and prednisone.
Located in the Emergency Department of Dr. Sótero del Río Hospital, for two weeks of progressive dyspnea, episodes of generalized edema and generalized edema associated with intense oppressive precordalgia.
He reported a significant decrease in muscle mass in the last 3 months, and alopecia, photosensitivity and oral ulcers also appeared.
Upon admission, he was pale, polypneic, without desaturation, tachy, normotensive and with jugular engorgement.
Pulmonary mucus abolished biphasic, cardiac arrested tones, without murmurs.
The abdomen was distended, with visceral congestion, ascites and significant generalized peripheral edema.
Laboratory tests revealed anemia, lymphopenia, hypoalbuminemia and liver test abnormalities, with no change in renal function or significant proteinuria.
The electrocardiogram (ECG) showed sinus tachycardia and low voltage complexes.
A chest CT angiography ruled out pulmonary thromboembolism, revealing bilateral pleural effusion, pericardial thickening, ascites, soft tissue edema and contrast reflux to the inferior vena cava and suprahepatic veins.
The analysis showed pleural transudate and an albumin gradient > 1.1 in ascitic fluid.
Due to the stigmas established by recombination, C3 and C4 levels were determined, demonstrating positive hypocomplementemia, anti-DNA and ANA, the definitive diagnosis of SLE.
When cardiac involvement was suspected, a transthoracic echocardiogram was performed, which suggested periventricular constriction, confirmed by cardiac catheterization.
protein binding and beta-blockers along with diuretics and corticosteroids, hydroxychlorothioprine and azathioprine for four weeks, with poor response, persisting in anasarca, emalbuminemia
It was finally decided to perform pericardiectomy, surgery performed with cardiopulmonary bypass support, successfully.
After surgery, there was progressive improvement in general condition and functional capacity, resolution of the anasarca and other stigmata of right heart failure.
Liver tests and albuminemia normalized, achieving hospital admission and return home in satisfactory conditions.
Pericardial biopsy revealed chronic nonspecific pericarditis, extensive fibrosis, without caseifying granulomas.
PCR for tuberculosis was negative.
