title: Recurrent cardiac tamponade in a child with newly diagnosed systemic-onset juvenile idiopathic arthritis.
abstract: A previously healthy 5-year-old boy presented with prolonged fever, evanescent rash, and arthralgias. Diagnostic tests were significant for marked systemic inflammation. He rapidly developed pleural and pericardial effusions with cardiac tamponade, requiring placement of a pericardial drain. He briefly responded to nonsteroidal anti-inflammatory drugs and pulse methylprednisolone, but tamponade recurred shortly thereafter. Subsequently, he required high-dose intravenous immunoglobulin, infliximab, and anakinra. Thus, we report a patient with severe serositis and recurrent cardiac tamponade as the initial presentation of systemic juvenile idiopathic arthritis (sJIA) and review the literature regarding pericarditis and tamponade in sJIA. This potentially fatal complication of sJIA requires timely recognition and therapy to avoid significant morbidity and mortality.
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA. baszis_k@kids.wustl.edu
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Baszis
authors.forename: Gautam
authors.initials: G
authors.lastname: Singh
authors.forename: Andrew
authors.initials: A
authors.lastname: White
authors.forename: Akaluck
authors.initials: A
authors.lastname: Thatayatikom
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001171:Arthritis, Juvenile / Q000175:diagnosis* / Q000188:drug therapy; D002305:Cardiac Tamponade / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D004452:Echocardiography; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D010490:Pericardial Effusion / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D020519:Pericardiocentesis; D011239:Prednisolone / Q000627:therapeutic use; D012008:Recurrence; D014057:Tomography, X-Ray Computed
chemical_list: D000893:Anti-Inflammatory Agents; D011239:Prednisolone; D008775:Methylprednisolone