Pericardial Effusion and Lupus Nephritis in New Onset Systemic Lupus Erythematosus (SLE) Introduction: Systemic lupus erythematosus

(SLE) is a chronic inflammatory disease of unknown cause that can affect multiple organ systems such as kidneys, lungs, nervous system, serous membranes, skin, and joints. SLEs clinical course is variable and is often characterized by periods of remissions and relapses. It is frequently seen in young women, especially in their 20s and 30s, and often presents with myriad symptoms and involvement of many organ systems. A prominent characteristic of the disease is the production of a number of antinuclear antibodies and other immunologic abnormalities. We present a case of new onset SLE, diagnosed after initial presentation of dyspnea, with findings of cardiac effusion and tamponade, complicated by DVT, pulmonary embolism, and lupus nephritis. Case Report: 20 year old Mexican woman with history of Hepatitis C and anemia, presents with complaint of new onset and progressively worsening dyspnea and severe abdominal pain in context of bilateral upper and lower extremity joint swelling for past few months. On exam she had muffled heart sounds, rales, positive hepatojugular reflux, hepato- splenomegaly, bilateral hand and knee edema and bilateral cervical lymphadenopathy. Chest x-ray showed large bilateral pleural effusions with enlarged cardiac shadow. CT chest showed large bilateral effusions, large pericardial effusion, and right atrial collapse during diastole, consistent with tamponade physiology. Pericardial window and chest tubes were placed for drainage but patient developed complement driven angioedema requiring intubation. Infection was ruled out in time and patient was diagnosed with SLE based on criteria (lymphopenia, oral ulcers, positive ANA, low complement, arthritis , anemia, serositis). During hospital course, patient developed lower extremity DVT and pulmonary embolism, was found to be phospholipid antibody positive and subsequently developed massive proteinuria. Kidney biopsy showed diffuse segmental proliferative sclerosing glomerulonephritis, consistent with Class IV Lupus nephritis. Discussion: This case illustrates the variable possible presentations and the rapid and severe complications of SLE. It can begin with myriad symptoms, minor or major, and, as this case alerts us, can quickly deteriorate into life-threatening complications. In patients with new-onset seemingly unconnected symptoms from various organ systems, health care providers should keep in mind the possibility of SLE, especially in young women.