title: Procainamide-induced lupus erythematosus pericarditis encountered during coronary bypass sugery.
abstract: Procainamide is probably the most common offending drug responsible for the drug-induced lupus erythematosus syndrome today. Pericarditis has been reported to occur in from 14 to 18 per cent of the cases of procainamide-induced lupus erythematosus, and occasional reports of massive pericardial effusion, pericardial tamponade and constrictive pericarditis have appeared in the literature. We describe a patient who presented with features of procainamide-induced lupus erythematosus without any clinical evidence of pericarditis. He underwent coronary bypass surgery 12 days after administration of the drug was stopped and was found to have a significant pericardial effusion at the time of surgery; histologic examination of pericardial tissue and pericardial fluid confirmed that the pericardial effusion was related to the procainamide-induced lupus syndrome. The incidence of pericarditis in procainamide-induced lupus erythematosus may be higher than presently accepted figures would indicate. Symptoms and signs related to procainamide-induced lupus pericarditis may cause diagnostic confusion with common postoperative bypass complications; the full implications of this disease entity to the patient undergoing coronary bypass are unknown.
mesh_terms: D001706:Biopsy; D001026:Coronary Artery Bypass; D006801:Humans; D007431:Intraoperative Complications; D008180:Lupus Erythematosus, Systemic / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D010490:Pericardial Effusion / Q000166:cytology; D010493:Pericarditis / Q000139:chemically induced* / Q000175:diagnosis; D010496:Pericardium / Q000473:pathology; D011342:Procainamide / Q000009:adverse effects*
chemical_list: D011342:Procainamide