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Hemorrhagic Cardiac Tamponade as a Complication of Limited Cutaneous Systemic Sclerosis.

التفاصيل البيبلوغرافية
العنوان: Hemorrhagic Cardiac Tamponade as a Complication of Limited Cutaneous Systemic Sclerosis.
المؤلفون: Sami F; Internal Medicine, Allama Iqbal Medical College, Lahore, PAK., Sami SA; Internal Medicine, Trinity Health Oakland Hospital, Pontiac, USA., Tanveer S; Internal Medicine, Army Medical College, National University of Medical Sciences (NUMS), Rawalpindi, PAK., Sami H; Anatomy, Physiology, and Biochemistry, Shalamar Medical and Dental College, Lahore, PAK.
المصدر: Cureus [Cureus] 2023 Jun 04; Vol. 15 (6), pp. e39947. Date of Electronic Publication: 2023 Jun 04 (Print Publication: 2023).
نوع المنشور: Case Reports
اللغة: English
بيانات الدورية: Publisher: Cureus, Inc Country of Publication: United States NLM ID: 101596737 Publication Model: eCollection Cited Medium: Print ISSN: 2168-8184 (Print) Linking ISSN: 21688184 NLM ISO Abbreviation: Cureus Subsets: PubMed not MEDLINE
أسماء مطبوعة: Original Publication: Palo Alto, CA : Cureus, Inc.
مستخلص: Cardiac tamponade is an uncommon complication of systemic sclerosis (SSc) with a high mortality rate. Here, we report a case of a 58-year-old patient with limited cutaneous systemic sclerosis (lcSSc), gastroesophageal reflux disease (GERD), diabetes mellitus, pulmonary hypertension (PHTN), and COVID-19 infection, which occurred one month ago, presenting with a large hemorrhagic pericardial effusion and early cardiac tamponade. The patient had an acute onset of progressive dyspnea and anasarca. On examination, she was tachypneic, tachycardic, desaturating on room air, and hypotensive. Pitting edema up to thighs and bilateral basilar crackles were also appreciated. Labs were remarkable for negative troponin, chest X-ray with pulmonary congestion, D-dimer at 6.01, CT angiogram negative, brain natriuretic peptide level at 73 pg/mL, C-reactive protein level at 7.64 mg/dL, normal complement levels, and negative COVID-19 test results. Echocardiography showed early tamponade and a large circumferential effusion with chamber collapse. Right heart catheterization was performed finding PHTN at 54 mmHg. Pericardiocentesis drained 500 mL of the hemorrhagic effusion. Fluid analysis showed RBC at 220,000/uL, WBC at 5000/uL, protein 4.8 g/dL, lactate dehydrogenase level of 1275 U/L, and negative cytology. The patient was treated for serositis from lcSSc flare with mycophenolate mofetil and steroids, and responded very well. Hemorrhagic cardiac tamponade is a very rare phenomenon in limited scleroderma. A recent COVID-19 infection could have served as a trigger factor for our patient's lcSSc in long remission to flare up. Clinicians should maintain a high index of suspicion and a low threshold for intervention when lcSSc patients have an acute onset of cardiac compromise, especially with a history of a recent COVID-19 infection.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright © 2023, Sami et al.)
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فهرسة مساهمة: Keywords: limited cutaneous systemic sclerosis; pericardial effusion; scleroderma; systemic sclerosis; tamponade
تواريخ الأحداث: Date Created: 20230607 Latest Revision: 20230608
رمز التحديث: 20240628
مُعرف محوري في PubMed: PMC10239686
DOI: 10.7759/cureus.39947
PMID: 37283596
قاعدة البيانات: MEDLINE
الوصف
تدمد:2168-8184
DOI:10.7759/cureus.39947