Cardiac tamponade due to haemorrhagic effusion: an unusual first manifestation of systemic lupus erythematosus.

A 31-year-old woman with hypothyroidism on thyroxine replacement presented with a 1-month history of pleuritic chest pain, worsening dyspnoea and fever. She was ill-looking, with a temperature of 38.7°C, blood pressure of 92/50 mmHg and heart rate of 106/min. Cardiac examinations revealed pericardial rub, presence of pulsus paradoxus and elevated jugular venous pressure. Chest radiograph revealed cardiomegaly (see figure …