# Rapidly Progressive Cardiac Tamponade in Uncontrolled Rheumatoid Arthritis Complicated by Diabetic Ketoacidosis

## TL;DR

A woman with uncontrolled rheumatoid arthritis and diabetes died from a severe heart complication and diabetic ketoacidosis.

## Contribution

This case highlights the rare but severe cardiac complication of cardiac tamponade in rheumatoid arthritis.

## Key findings

- Rapidly progressive cardiac tamponade occurred in a patient with uncontrolled rheumatoid arthritis.
- The patient also had diabetic ketoacidosis, leading to multi-organ dysfunction and death.
- Early recognition and intervention are critical for life-threatening extra-articular manifestations of rheumatoid arthritis.

## Abstract

Rheumatoid arthritis (RA) can involve extra-articular organs, including the heart, with pericardial effusions being common but rarely progressing to cardiac tamponade. We report a 42-year-old female with uncontrolled RA, markedly elevated anti-cyclic citrullinated peptide (anti-CCP) and rheumatoid factor (RF), and type 2 diabetes mellitus, who presented with severe chest pain, shortness of breath, and diabetic ketoacidosis. Rapid accumulation of a large pericardial effusion led to cardiac tamponade, requiring emergency pericardial drainage during a peri-arrest state. Despite aggressive critical care, she developed hypoxic brain injury and multi-organ dysfunction, ultimately leading to death. This case highlights the importance of early recognition of cardiac involvement in RA, the potential severity of extra-articular manifestations even in the absence of active joint disease, and the need for prompt intervention in life-threatening complications.