Cardiac tamponade as a manifestation of severe dermatomyositis.
In connective tissue disorders, the incidence of pericardial disease and pericardial effusion can be up to 58%, and if untreated, it can lead to cardiac tamponade which can be fatal. Physicians must have a high index of suspicion for this disease as diagnosis can be delayed while evaluating more common causes of tachycardia and hypotension in the immunosuppressed (ie, sepsis). We present a 55-year-old woman with a severe case of dermatomyositis, marked by significant weight loss, a bedridden state and hallmark cutaneous findings. On evaluation of interstitial lung disease, a pericardial effusion was incidentally noted. Serial examination revealed increasing fluid accumulation and progressive tachycardia, and diagnosis of cardiac tamponade was made on echocardiography. After initial pericardiocentesis, the effusion rapidly re-accumulated requiring a pericardial window. In severe presentations of rheumatic disease, cardiac tamponade should be considered as a cause of tachycardia, with or without associated hypotension.
Department of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
Benjamin James
BJ
Kurth
Department of Rheumatology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
Vanya
V
Wagler
Department of Rheumatology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
Michael
M
Keith
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