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Case Reports
. 2026 Jan 22;18(1):e102066.
doi: 10.7759/cureus.102066. eCollection 2026 Jan.

Massive Pericardial Effusion and Type 3 Cardiorenal Syndrome as the Inaugural Presentation of Late-Onset Systemic Lupus Erythematosus in a Septuagenarian

Sergio David Angulo  1 , Cesar Cortes  1 , Manuela Orozco  2 , Juan Diego Trujillo Loaiza  3 , Diego Ruiz  4 , Juan Pablo Rodríguez  5 , Laura Fernanda Giraldo Nieto  6
Affiliations
Case Reports

Massive Pericardial Effusion and Type 3 Cardiorenal Syndrome as the Inaugural Presentation of Late-Onset Systemic Lupus Erythematosus in a Septuagenarian

Sergio David Angulo et al. Cureus. .

Abstract

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by inflammation and immune-mediated damage with mucocutaneous, musculoskeletal, cardiopulmonary, and renal involvement. It typically affects younger women; however, late-onset presentations can occur and often display distinct clinical features. We report the case of a septuagenarian woman who presented with massive pericardial effusion and type 3 cardiorenal syndrome. Further evaluation revealed class IV lupus nephritis, confirming a diagnosis of late-onset SLE according to the 2019 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) criteria. Cardiac and serous membrane involvement is more common in late-onset SLE than in classical SLE.

Keywords: chronic kidney disease; heart failure; late-onset systemic lupus erythematosus; lupus; lupus nephropathy.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Comfamiliar Clinic Ethics Committee issued approval 00139. 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. (A) Anteroposterior chest X-ray demonstrating cotton-wool infiltrates (arrows), cardiomegaly, and bilateral pericardial and pleural effusions. (B) Lung ultrasound image showing a large, 1000 mL left pleural effusion (arrow)
Figure 2
Figure 2. Renal biopsy (40×). Sections stained with (A) hematoxylin and eosin (H&E), (B) trichrome, and (C) silver stain demonstrating features of membranoproliferative glomerulonephritis
Figure 3
Figure 3. Direct and indirect mechanisms of type 3 cardiorenal syndrome in lupus nephropathy
RAA: renin-angiotensin-aldosterone system Figure Source: Liu et al. [10]; reproduced under the Creative Commons Attribution License (CC BY 4.0)
See this image and copyright information in PMC

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