Hemorrhagic Pericardial Effusion in Systemic Lupus Erythematous (SLE) Prompt Diagnosis and Treatment

Background: Pericardial effusion can be as cardiac manifestation of systemic lupus erythematous (SLE), which is usually serous fluid. Hemorrhagic pericardial effusion is unusual clinical sign of SLE. Pericardial effusion is an abnormal accumulation of fluid in the pericardial cavity it can be either serous, serosanguineous, or hemorrhagic. The most common causes of hemorrhagic pericardial effusion are malignancy, tuberculosis, trauma and complication of myocardial infarction. The aim of this report is to recognize unusual clinical sign of SLE and to decide early treatment for life saving in SLE case. Case: A 13 years old female presented with shortness of breath, difficult to lying on the bed but get better on sit position. Echocardiography investigation showed pericardial effusion. Pericardiocentesis then become the choose of treatment, it was showed bloody fluid. Clinical and laboratory examination did not showed sign of malignancy, tuberculosis, trauma, nor myocardial infarction. Further investigation then guide the diagnosis to SLE, which full filled 6 point out of 16 point of SLICC criteria. High dose methylprednisolone (HDMP) was as the choose of initial treatment followed by cyclophosphamide. After first HDMP administration, patient got dramatically improvement by the production of pericardial effusion. Patient was discharge in the good condition. Conclusion: SLE can occur in unusual manifestation like hemorrhagic pericardial effusion. Early SLE diagnosis will prompt a thorough evaluation and diligent follow-up which can minimize the disease comorbidities and improve its outcomes.