Diagnosis and management challenges of recurrent lupus pericarditis in pregnancy: A case report

Abstract

Systemic lupus erythematosus (SLE) is an autoimmune multisystem disease. Pericarditis in SLE can lead to severe effusion and cardiac tamponade, and is associated with significant morbidity and mortality. Therefore, early diagnosis and treatment are essential. A 32-year-old woman at 21 weeks of gestation with a history of lupus pericarditis two years previously presented to the emergency department with shortness of breath, fever, and weakness. Transthoracic echocardiography revealed a massive pericardial effusion, right ventricle failure, pulmonary hypertension, severe tricuspid regurgitation, and mild mitral regurgitation. A chest X-ray suggested pericardial effusion accompanied by pulmonary edema. Due to worsening of the patient's health, a joint decision was made with her and her family to terminate the pregnancy. Most cardiac manifestations of SLE worsen during pregnancy and can lead to life-threatening conditions such as cardiac tamponade or congestive heart failure. This is a rare case of recurrent lupus pericarditis in pregnancy accompanied by massive pericardial effusion, heart failure and pulmonary edema. Management is challenging because the most effective drugs are known to be harmful to the fetus.