Pericarditis is the most common cardiovascular manifestation of systemic lupus erythematosus and affects a substantial proportion of patients during the course of the disease. Although it is often mild and self-limiting, lupus-associated pericarditis can result in substantial morbidity due to recurrent episodes and potentially life-threatening complications, including cardiac tamponade and constrictive pericarditis. Recent advances have expanded our understanding of its immunopathogenesis, highlighting the interplay between immune complex deposition, complement activation, type I interferon signaling, and dysregulated cell death pathways. Diagnostic evaluation relies on clinical assessment supported by electrocardiography and transthoracic echocardiography, while cardiac MRI has emerged as a valuable modality for detecting active inflammation, characterizing pericardial tissue involvement, and identifying constrictive physiology. In contrast to idiopathic pericarditis, management strategies should address both pericardial inflammation and the underlying autoimmune disease activity. Colchicine has become a cornerstone of therapy owing to its effectiveness in symptom control and recurrence prevention, whereas glucocorticoids and immunosuppressive agents remain essential for selected patients with active systemic disease. Emerging targeted therapies, including anifrolumab, belimumab, and IL-1 inhibitors, offer promising alternatives for refractory or recurrent cases, although disease-specific evidence remains limited. This review provides a comprehensive overview of the current understanding of lupus-associated pericarditis, encompassing its pathophysiology, clinical manifestations, diagnostic approach, and therapeutic management, while highlighting recent advances and key areas for future research.

Cardiac tamponade is a medical/traumatic emergency characterized by the increased intrapericardial pressure from the accumulation of excessive fluid (either exudate, transudate, or blood) in the pericardium. Emergency sonography is a vital part of the rapid assessment of cases with traffic accidents and chest traumas, as pericardial injuries are among the hidden affected organs. Here, we present a case of successful resuscitation of cardiac tamponade.

We report the case of a 70-year-old female with a history of hypothyroidism who presented following an unwitnessed fall with bradycardia and hypothermia. She was found to have myxedema coma complicated by signs of early cardiac tamponade, requiring urgent pericardiocentesis. Myxedema coma is a rare but life-threatening manifestation of severe decompensated hypothyroidism, carrying a high mortality rate despite treatment. It commonly presents with hypothermia and altered mental status and may be precipitated by infection, trauma, medication nonadherence, or cold exposure. Early recognition and prompt treatment with intravenous stress-dose steroids and thyroid hormone replacement are essential to improve outcomes. This case highlights the potentially severe complications of inadequately treated hypothyroidism. It emphasizes the importance of considering cardiac tamponade as a rare but life-threatening consequence of this disease, requiring a high index of suspicion, timely diagnosis, and urgent intervention.

Primary purulent pericarditis due to Streptococcus pyogenes is exceedingly rare in adults, with fewer than 10 cases reported in the literature to date. Most reported cases have occurred in the setting of an immunocompromised state, thoracic procedures, or identifiable infectious foci.

Candida pericarditis is a rare, life-threatening complication of invasive candidiasis, associated with high mortality. We report this case of a young woman with 60% body surface area burn, multidrug-resistant polymicrobial sepsis, and multiorgan failure who developed Candida albicans pericarditis complicated by cardiac tamponade. Despite urgent pericardiocentesis and escalation of antifungal therapy, she ultimately progressed to refractory shock and multiorgan failure. This case illustrates the diagnostic challenge and therapeutic limitations of fungal pericarditis in critically ill host, and underscores the importance of maintaining a high index of suspicion in burn patients with multisite Candida colonization and prolonged antibiotic exposure.

Melioidosis is a serious infectious disease caused by Burkholderia pseudomallei, a bacterium endemic to tropical regions, including Taiwan. The disease can involve multiple organs; however, cardiac involvement, particularly cardiac tamponade, is rare. To date, only four cases of melioidosis presenting with cardiac tamponade have been reported in the literature. Here, we report an extremely rare case of melioidosis complicated by pericardial effusion and cardiac tamponade, which was successfully treated with pericardiocentesis and appropriate antimicrobial therapy.

Systemic lupus erythematosus (SLE) can closely mimic rheumatoid arthritis, leading to diagnostic delays. In patients with atypical inflammatory arthritis, early echocardiographic evaluation is vital to detect rare but life-threatening complications like cardiac tamponade, ensuring prompt transition from RA-directed therapy to life-saving immunosuppression.

BACKGROUND Hydatid disease, caused by Echinococcus granulosus, is an endemic parasitic infection that predominantly affects the liver. Although slow-growing and asymptomatic, large hepatic cysts lead to catastrophic vascular complications, including inferior vena cava (IVC) thrombosis and pulmonary embolism (PE). Although rare, life-threatening events require prompt recognition and multidisciplinary management to optimize outcomes. CASE REPORT A 68-year-old woman with paroxysmal atrial fibrillation presented with right upper-quadrant pain, fever, and poor oral intake for several weeks. Examination revealed abdominal distension, hepatomegaly, and mottled, cold lower limbs. Laboratory findings showed severe metabolic acidosis and leukocytosis, indicating significant systemic involvement and possible sepsis. Computed tomography (CT) angiography demonstrated a pulmonary embolism, a giant (29×18 cm) right hepatic cyst exerting a mass effect, and extensive thrombosis extending from the infrarenal IVC to both external iliac veins. Echocardiography showed extrinsic cardiac compression without signs of tamponade but with functional compromise related to mass effect. Management included anticoagulation, albendazole, broad-spectrum antibiotics, vasopressors, and continuous renal replacement therapy. Ultrasound-guided percutaneous drainage of the cyst yielded 4 L of purulent fluid, with transient improvement in limb perfusion suggesting partial decompression of venous outflow obstruction. An IVC filter was inserted, but despite intensive therapy, the patient developed refractory shock and died due to progressive hemodynamic collapse and multiorgan failure. CONCLUSIONS Massive hepatic hydatid cysts can precipitate IVC thrombosis and PE through mechanical compression or infection-related inflammation. Early diagnosis, multidisciplinary coordination, and timely surgical or percutaneous decompression are vital to prevent death.

Acute traumatic cardiac tamponade is a time-critical-but potentially reversible-cause of circulatory collapse. The surgical, operative, nursing and anaesthesiology staff most capable and best trained to perform the procedure are often not immediately available, requiring emergency medical staff to perform this life-saving intervention. When tamponade causes refractory shock or peri-arrest, left anterolateral thoracotomy remains the preferred technique for definitive pericardial decompression, with extension to a clamshell thoracotomy when required.