SLE or hypothyroidism: who can triumph in cardiac tamponade?
A 36-year-old Hispanic woman with a history of systemic lupus erythaematosus (SLE) in remission presented with progressive dyspnoea, bilateral leg swelling and increasing fatigue with rapid weight gain over the past few months. Her physical examination showed mildly tender thyromegaly and pericardial rub. Investigations showed new onset marked hypothyroidism as well as an active lupus serology with echocardiogram confirming severe pericardial effusion and a tamponade phenomenon. Urgent pericardiocentesis relieved her acute symptoms, and prompt treatment with thyroxine replacement and immunosuppression for lupus disease was initiated. Pericardial fluid analysis remained negative for any malignancy and/or infection/s. The patient had a gradual and consistent improvement with this treatment. She was discharged and appeared to be clinically stable at subsequent follow-up visits. However, the case remained a diagnostic dilemma over whether the tamponade was being driven by hypothyroidism versus lupus, leaving us with an opportunity to explore further.
Department of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey, USA.
Sameer Sadashiv
SS
Chaudhari
Department of Internal Medicine, Metropolitan Hospital Centre, New York, New York, USA.
Kashmira Pramod
KP
Wankhedkar
Department of Cardiology, Metropolitan Hospital Center, New York, New York, USA.
Savi
S
Mushiyev
D000328:Adult; D002305:Cardiac Tamponade / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D004417:Dyspnea / Q000175:diagnosis / Q000209:etiology*; D005221:Fatigue / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D010490:Pericardial Effusion / Q000209:etiology; D013974:Thyroxine / Q000627:therapeutic use*; D015430:Weight Gain
D013974:Thyroxine