Systemic lupus erythematosus should be considered in adults presenting with unexplained cardiac tamponade and hemolysis, even in the absence of classic mucocutaneous or musculoskeletal manifestations.
Systemic lupus erythematosus can present with varied clinical features, and life-threatening serositis or autoimmune hemolysis may precede more typical findings. We report a 56-year-old woman who presented with progressive dyspnea, pleuritic chest discomfort, hypotension, and tachycardia and was found to have a large pericardial effusion with tamponade physiology requiring urgent pericardiocentesis. During hospitalization, worsening anemia with positive direct antiglobulin testing, peripheral spherocytes, reticulocytosis, hyperbilirubinemia, low haptoglobin, and splenomegaly supported the diagnosis of warm autoimmune hemolytic anemia. Infectious, malignant, and other causes of inflammatory pericardial effusion were excluded. The overall presentation, including serositis, autoimmune hemolysis, and positive lupus serologies, supported the diagnosis of late-onset systemic lupus erythematosus. She was treated with pericardiocentesis, corticosteroids, transfusion support, intravenous immunoglobulin, rituximab, and later hydroxychloroquine, with resolution of the pericardial effusion and improvement in anemia. This case emphasizes that systemic lupus erythematosus should be considered in adults with otherwise unexplained cardiac tamponade accompanied by hemolysis, even when classic mucocutaneous or musculoskeletal manifestations are absent at presentation.
Almahmood et al. (2026) studied this question.