# 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.

## Key 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.