Abstract
The patient was a 74-year-old woman who had been diagnosed with rheumatoid arthritis in 1998 and started treatment at our outpatient clinic in 2001. She had been repeatedly hospitalized for aggravated arthritis and vertebral compression fracture, among other problems. In the beginning of April 2008, she first experienced exertional dyspnea. On April 25, she was transported to our hospital by ambulance due to worsening of exertional dyspnea and was hospitalized immediately. A chest radiograph showed marked cardiac enlargement, while a cardiac ultrasonographic study revealed impaired diastole due to massive hydropericardium, consistent with a diagnosis of cardiac tamponade. Purulent pericardial fluid was drained under fluoroscopy. The drained fluid was exudative, culture-negative for general or acid-fast bacteria, positive for rheumatoid factors, and showed low complement and high immune complex C1q levels.
We diagnosed the cause of cardiac tamponade as rheumatoid pericarditis from these results and started her on 40 mg/day of methylprednisolone, which prevented recurrence of pericardial effusion, leading to her discharge on June 3. Cardiac tamponade caused by rheumatoid pericarditis is a relatively uncommon pathologic condition complicated by late-stage rheumatoid arthritis. In this case, the patient recovered from this acutely morbid state with pericardial drainage and steroid administration.
