Unclassified connective tissue disease presenting as cardiac tamponade - Acase report

This report describes a case of cardiac tamponade as the initial manifestat ion of unclassified connective tissue disease (UCTD). A 68-year-old Japanes e woman was admitted to hospital because of dyspnea and edema. She had unde rgone a radical left mastectomy for the treatment of breast cancer 18 years before. On admission, bilateral leg edema, hepatomegaly, and a paradoxical pulse were noted on physical examination. The erythrocyte sedimentation ra te was elevated and the C-reactive protein was 2.8 mg/dl. Antinuclear antib odies and anti-SS-A/Ro antibodies were present. The scl-70 and anticentrome re antibodies were elevated. Chest radiography showed cardiomegaly. Echocar diography revealed a large pericardial effusion, but the pericardial fluid did not contain malignant cells or bacteria. She did not meet the diagnosti c criteria for any known connective tissue diseases, so was diagnosed with cardiac tamponade due to UCTD. Prednisolone (30 mg/day) was administered, w hich resulted in a gradual resolution of the pericardial effusion. Although connective tissue diseases are known to cause pericardial effusion, cardia c tamponade as the initial manifestation of the disease in the absence of o ther symptoms is quite rare.