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Case Reports
. 2025 Mar 4;17(3):e80042.
doi: 10.7759/cureus.80042. eCollection 2025 Mar.

Pericardial Effusion as the First Presentation of Systemic Lupus Erythematosus in a 22-Month-Old Infant: A Case Report and Literature Review

Anood Al Rawahi  1 , Saif Awlad Thani  2 , Mohammed Alriyami  3 , Abdullah Al Furqani  4 , Safiya Al-Abrawi  5
Affiliations
Case Reports

Pericardial Effusion as the First Presentation of Systemic Lupus Erythematosus in a 22-Month-Old Infant: A Case Report and Literature Review

Anood Al Rawahi et al. Cureus. .

Abstract

Childhood-onset systemic lupus erythematosus (cSLE) is a multi-systemic, inflammatory autoimmune disease that affects many organs including the heart. Pericardial effusion as a primary manifestation of SLE in early infancy is very rare. It has been reported as the first symptom of SLE in adult and adolescent case reports only and the youngest reported case was a three-year-old. We report a case of a 22-month-old infant who had previously been healthy but presented with pericardial effusion and a reduced ejection fraction of 20%. She progressed to cardiogenic shock and acute renal failure and required invasive ventilation, inotropic support and temporary dialysis. She was diagnosed with SLE that was genetically confirmed as autosomal recessive SLE. Her condition improved significantly after starting SLE management with immunosuppression therapy. Pericardial effusion has resolved with medical therapy only and cardiac dysfunction has recovered. According to the available literature, this is the youngest reported case of SLE manifesting as pericardial effusion. This case highlights the importance of including SLE in the differential diagnosis for infants presenting with pericarditis, myocarditis, or pericardial effusion to guide early intervention and reduce risks associated with the disease.

Keywords: immunosuppressive therapy; infant; lupus nephritis; pericardial effusion; systemic lupus erythematosus (sle).

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. The Royal Hospital Scientific Research Committee issued approval MOH/CSR/CR/25/1. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. At presentation the chest X-ray shows cardiomegaly
Figure 2
Figure 2. Transthoracic echocardiography (TTE) apical four chamber and parasternal short axis 2D view showing circumferential large pericardial effusion (at the time of presentation)
Figure 3
Figure 3. Transthoracic echocardiography (TTE) parasternal short axis 2D view showing circumferential large pericardial effusion (at the time of presentation)
Figure 4
Figure 4. Chest X-ray at day five of admission shows cardiomegaly and pulmonary edema
Figure 5
Figure 5. Follow-up echocardiography after six months showing minimal pericardial effusion (apical four chamber view)
Figure 6
Figure 6. Follow-up echocardiography after six months showing minimal pericardial effusion (parasternal short axis 2D view)
See this image and copyright information in PMC

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