Abstract
Background: Acute pericarditis is rare in children; it can evolve to effusion or even cardiac tamponade. The main infectious agents are viruses and bacteria. The pharmacological treatment includes NSAIDs; just a few patients need pericardiocentesis.
Clinical case: A school-age patient was hospitalized because of chest pain; she was diagnosed with acute pericarditis and pericardial effusion, without any other symptoms. The disease pattern then evolved to dry cough, crushing epigastric abdominal pain, vomiting and fever. Due to a poor response to the initial treatment, immunological studies were requested. She tested positive to antinuclear antibodies (ANA), anti-double stranded DNA, direct Coombs and anticardiolipin antibodies; hypocomplementemia with lymphopenia was detected too, which is an indicative of systematic lupus erythematosus.
Conclusions: The torpid evolution or recurrence of pericarditis must direct toward excluding neoplastic or autoimmune bodies. Cardiovascular manifestations rarely appear initially in patients with Systemic Lupus Erythematosus.
References
Palanca-Arias D, Corella-Aznar EG, Ayerza-Casas A, Ayerza-Casas A, Fernández-Gómez A, López-Ramón M, et al. Pericarditis aguda complicada con derrame pericárdico. Caso clínico pediátrico. Arch Argent Pediatr. 2017;115(4):e237-e242. Disponible en: https://www.sap.org.ar/docs/publicaciones/archivosarg/2017/v115n4a24.pdf
Faustino M, Carmo-Mendes I, Anjos R. Constrictive pericarditis: a challenging diagnosis in paediatrics. Hindawi. 2015;2015:402740. DOI: 10.1155/2015/402740
Rigante D, Napodano S, Lucherini OM, Magnotti F, Muscari I, Guerrini S, et al. Idiopathic recurrent acute pericarditis: a cross talk between autoimmunity and autoinflammation. J Genet Syndr Gene Ther. 2013;S3:003. DOI: 10.4172/2157-7412.S3-003
Roodpeyma S, Sadeghian N. Acute pericarditis in childhood: a 10-year experience. Pediatr Cardiol. 2000;21:363-367. DOI: 10.1007/s002460010081
Silva CA. Childhood-onset systemic lupus erythematosus: early disease manifestations that the paediatrician must know. Expert Rev Clin ImmunoL. 2016;12(9):907-910. DOI: 10.1080/1744666X.2016.1195685
Alabed S, Pérez-Gaxiola G, Burls A. Colchicine for children with pericarditis: systematic review of clinical studies. Arch Dis Child. 2016;101(10):953-956. DOI: 10.1136/archdischild-2015-310287
Raatikka M, Pelkonen PM, Karjalainen J, Jokinen EV. Recurrent pericarditis in children and adolescents. Report of 15 Cases. JACC. 2003;42(4):759-764.
Azagoh-Kouadio R, Enoh JS, Yao-Atteby J, Guei-Couitchéré L, Cisse L, N’da Kouakou-N’goran Y, et at. Etiological and evolutionary profile of the child’s pericarditis in tropical environments. Open J Pediatr. 2017;7(3):164-177. DOI: 10.4236/ojped.2017.73020
Bagri NK, Yadav DK, Agarwal S, Aier T, Gupta V. Pericardial effusion in children: experience from tertiary care center in northern India. Indian Pediatr. 2014;51(15):211-213. Disponible en: https://www.indianpediatrics.net/mar2014/211.pdf
Shakti D, Hehn R, Gauvreau K, Sundel RP, Newburger JW. Idiopathic pericarditis and pericardial effusion in children: contemporary epidemiology and management. J Am Heart Assoc. 2014;3:1-19. DOI: 10.1161/JAHA.114.001483
Picco P, Brisca G, Traverso F, Loy A, Gattorno M, Martini A. Successful treatment of idiopathic recurrent pericarditis in children with interleukin-1beta. receptor antagonist (anakinra). An unrecognized autoinflammatory disease? Arthritis Rheum. 2009;60(1):e264-e268. DOI: 10.1002/art.24174
Bousfiha A, Jeddane L, Picard C, Ailal F, Bobby Gaspar H, Al-Herz W, et. al. The 2017 IUIS phenotypic classification for primary immunodeficiencies. J Clin Immunol. 2018;38(1):129-143. DOI: 10.1007/s10875-017-0465-8
Blancas L, Guevara M, Espinosa F. Lupus eritematoso sistémico en niños, una revisión de la supervivencia. Alerg Asma Inmunol Pediatr. 2009;18(1):6-9. Disponible en: http://www.medigraphic.com/pdfs/alergia/al-2009/al091b.pdf
Bakr A. Epidemiology treatment and outcome of childhood systemic lupus erythematosus in Egypt. Pediatr Nephrol. 2005;20(8):1081-1086. DOI: 10.1007/s00467-005-1900-2
Bader-Meunier B, Armengaud JB, Haddad E, Salomon R, Leblanc T, Loirat C, et al. Initial presentation of childhood-onset systemic lupus erythematosus: a French multicenter study. J Pediatr. 2005;146(5):648-653. DOI: 10.1016/j.jpeds.2004.12.045
Elusiyan JBE, Olowu WA. Pericarditis as initial clinical manifestation of systemic lupus erythematosus in a girl. South African J Child Health. 2011;5(4). Disponible en: https://www.ajol.info/index.php/sajchh/article/view/73432/62347
Sharda N. Cardiac tamponade as an initial manifestation of systemic lupus erythematosus in a child. Cardiol Young. 2014;24(1):172-174. DOI: 10.1017/S1047951112001916
Aiuto LT, Stambouly JJ, Boxer RA. Cardiac taponade in an adolescent female: an unusual manifestation of systemic lupus erithematosus. Clin Pediatr (Phila). 1993;32(9):566-567. DOI: 10.1177/000992289303200914
Levy DM, Kamphuis S. Systemic lupus erythematosus in children and adolescents. Pediatr North Am. 2012;59(2):345-364. DOI: 10.1016/j.pcl.2012.03.007
Maharaj SS, Chang SM. Cardiac tamponade as the initial presentation of systemic lupus erythematosus: a case report and review of the literature. Pediatr Rheumatol Online J. 2015;13:9. DOI: 10.1186/s12969-015-0005-0
Petri M, Orbai AM, Alarcón GS, Gordon C, Merrill JT, Fortin PR, et al. Derivation and validation of the Systemic Lupus International Collaborating Clinics Classification criteria for systemic lupus erythematosus. Arthritis Rheum. 2012;64(8):2677-2686. DOI: 10.1002/art.34473
Petri M. Review of classification criteria for systemic lupus erythematosus. Rheum Dis Clin North Am. 2015;31(2):245-254. DOI: 10.1016/j.rdc.2005.01.009

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