title: A second case of pericardial mesothelioma mimicking systemic lupus erythematosus in the literature in over 30 years: a case report.
abstract: BACKGROUND
  Mesothelioma is a rare neoplasm which commonly develops in the pleura of people exposed to asbestos. Pericardial mesothelioma accounts for only 0.7 % of all malignant mesotheliomas and it usually presents with pericardial effusion, mimicking serositis. To date, there are approximately 200 cases of pericardial mesothelioma described in the medical literature, and little knowledge exists about the systemic manifestations of this pathology. The first and only described case of pericardial mesothelioma with autoimmune features dates back to 1984 and, in our case report, we describe the second.
  
  
  METHODS
  We report a case of a 45-year-old white woman whose pericardial mesothelioma was initially misdiagnosed as pericardial involvement of an autoimmune disease (systemic lupus erythematosus). After several relapses of pericardial effusion, a computed tomography scan and a biopsy with histological analysis were performed revealing neoplastic growth.
  
  
  CONCLUSIONS
  We describe a rare case of pericardial mesothelioma in a patient with a clinical presentation compatible with lupus serositis. Clinicians should consider malignant mesothelioma in the differential diagnosis of pericardial effusion, especially when it is recurrent and not clearly explained by other causes. Cytological samples should always be obtained and, if imaging tools are suggestive for solid processes, histological confirmation is mandatory.
authors.affiliation: Department of Preventive Medicine, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, via San Barnaba 8, 20122, Milan, Italy.
authors.forename: Carolina
authors.initials: C
authors.lastname: Mensi
authors.affiliation: School of Occupational Medicine, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, via San Barnaba 8, 20122, Milan, Italy. alessandro.romano@unimi.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Romano
authors.affiliation: Department of Allergy and Clinical Immunology, San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy.
authors.forename: Alvise
authors.initials: A
authors.lastname: Berti
authors.affiliation: Institute of Radiology, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi, 27100, Pavia, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Dore
authors.affiliation: Department of Preventive Medicine, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, via San Barnaba 8, 20122, Milan, Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: Riboldi
mesh_terms: D003937:Diagnosis, Differential; D004452:Echocardiography; D017809:Fatal Outcome; D005260:Female; D006338:Heart Neoplasms / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis*; D008654:Mesothelioma / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D008875:Middle Aged; D010490:Pericardial Effusion / Q000209:etiology / Q000628:therapy; D020519:Pericardiocentesis; D010496:Pericardium / Q000000981:diagnostic imaging; D011859:Radiography; D013997:Time Factors; D014057:Tomography, X-Ray Computed
keywords: Asbestos; Case report; Pericardial effusion; Pericardial mesothelioma; Pericarditis; SLE