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

TL;DR

A 70-year-old woman presented with heart and kidney issues as her first signs of late-onset lupus.

Contribution

This case highlights unique clinical features of late-onset SLE, specifically cardiac and serous membrane involvement.

Findings

Late-onset SLE can present with massive pericardial effusion and cardiorenal syndrome.

Class IV lupus nephritis was confirmed in the patient using updated diagnostic criteria.

Cardiac involvement is more common in late-onset SLE compared to classical SLE.

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.

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