She had wide spread hyper pigmented macules and papules over the back and extremities. Physical exam revealed fine crackles along the bases and absent pedal edema. On arrival to the ED, she was afebrile, had tachypnea and tachycardia with stable blood pressure. She also had remote colon cancer treated with partial colectomy. She had extensive past medical history significant for chronic kidney disease (CKD) stage III, hypertension, coronary artery disease and history of remote myocardial infarction complicated by right ventricular (RV) aneurysm with mural thrombus treated with warfarin therapy, and sick sinus syndrome managed with a pacemaker. Patient had been following regularly at the cardiology clinic. Other symptoms include weight loss of 30 lb over 5 months, pain in both knees and hips, as well as swelling and numbness in her right-hand fingers. Case ReportĪn 81-year-old female presented to the emergency department (ED) complaining of progressive shortness of breath over the preceding few weeks. The patient’s condition was controlled with steroids and follow-up echocardiogram showed resolution of the pericardial effusion. Pericardial tissue biopsy showed fibrinous pericarditis and further serology confirmed positive anti-RNP. Here we describe the case of an 81-year-old female who presented with new onset hemorrhagic pericardial effusion requiring drainage and pericardial window. Tamponade on the other hand is a rare manifestation of the disease with limited literature describing such presentation. Pericarditis is the most common cardiac manifestation of the disease and can affect all layers of the heart. The disease has a wide spectrum of clinical manifestations due to the involvement of various body organs including the heart. The disease is characterized by overlapping features characteristic of systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), systemic sclerosis (SSc), and polymyositis/dermatomyositis (PM/DM), along with the presence of antibodies to ribonucleoprotein (anti-RNP). Mixed connective tissue disease (MCTD) was first described by Sharp et al in 1972 as a distinct entity of connective tissue disease. Keywords: Cardiac tamponade Pericardial window Mixed connective tissue disease Ribonucleoprotein antibodies Introduction
#Trivial pericardial effusion serial
Early recognition, prompt treatment, and regular follow-up with serial echo are essential for treatment. This case highlights a very rare complication of the disease. While pericarditis is commonly associated with MCTD, pericardial tamponade on the other hand is rarely described. Biopsy of pericardial tissue revealed fibrinous pericarditis. Laboratory investigations showed positive ribonucleoprotein antibodies. Echocardiogram revealed severe rapidly accumulating pericardial effusion causing tamponade necessitating pericardial window.
In this case, we describe an elderly female patient with multiple complaints without a clear etiology on presentation.
The prevalence of cardiac involvement in MCTD varies from 13% to 65% and accounts for approximately 20% of MCTD related mortality. Mixed connective tissue disease (MCTD) is a distinct entity of connective tissue disorders characterized by overlapping clinical features of various autoimmune diseases along with the presence of antibodies to ribonucleoprotein (anti-RNP).
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