Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by multisystem involvement, and mainly occurs in young women. In contrast, late onset SLE, which is diagnosed at or above 50 years of age, accounts for about 12％-18％ of all patients with SLE. In this group, the occurrence of serositis and lung involvement is higher, but skin manifestations, photosensitivity, arthralgia, and nephritis are less frequent in comparison to early onset lupus patients. Moreover, there are 3 case reports with very late onset SLE which was diagnosed at or above the age of 80.Here, we report an 83-year-old man presenting with fever, polyarthralgia, and massive pericardial effusion. Infection and malignancy were ruled out, and positive anti-nuclear antibody, anti-DNA antibody, and lymphopenia led to the diagnosis of SLE. One week after initiation of prednisolone, however, he died suddenly. In the autopsy, visceral pericardium and parietal pericardium were tightly adhered and pericardial space was nearly obliterated. Pericardial effusion was bloody, but scarcely observed. Diffuse deposition of IgG at the site of pericarditis was also observed. The cause of his death was due to fibrinofibrous pericarditis. To date, this is the first case of very late onset male SLE with fibrinofibrous pericarditis and suggests that fibrous organization of pericardial effusion in lupus patients is more progressive than we had thought.
