Systematic review of culture-confirmed septic pericarditis in systemic lupus erythematosus with an index case.
Pericardial involvement is common in systemic lupus erythematosus (SLE), but distinguishing sterile immune-mediated pericarditis from septic pericarditis is difficult because clinical features overlap with sepsis, immunosuppressive effects and nonspecific serologic abnormalities. Septic pericarditis in SLE is rare yet potentially fatal and existing evidence is limited to isolated case reports.
We describe a fatal case of a patient in the fourth decade of life with newly diagnosed SLE who developed methicillin-resistant Staphylococcus aureus (MRSA) purulent pericarditis. Despite broad-spectrum antibiotics and immunosuppressive therapy for multisystem lupus activity, the patient deteriorated rapidly due to MRSA-positive pericarditis.
In parallel with this index case, we systematically searched PubMed/MEDLINE, Google Scholar and ResearchGate for case reports and series of microbiologically confirmed septic or purulent pericarditis in SLE, from inception to March 2025 and updated through November 2025. Two reviewers independently screened studies; extracted relevant clinical, microbiologic, immunologic and outcome data; and synthesised findings descriptively.
Fifteen published culture-confirmed cases plus our index case were identified (total n=16). Most patients were female (93.8%), with a mean age of 34.1 years. Staphylococcus aureus (including MRSA) and Salmonella species predominated. Dyspnoea (68.8%) was more frequent than fever (31.3%) and nearly all patients progressed to cardiac tamponade requiring urgent drainage. Survival was 93.8% when timely pericardial drainage and pathogen-directed antimicrobial therapy were achieved, while routine serological markers failed to distinguish infection from lupus flare.
Septic pericarditis in SLE is uncommon but rapidly progressive. Early echocardiography and a low threshold for diagnostic pericardiocentesis are essential to prevent fatal delay.
We describe a fatal case of a patient in the fourth decade of life with newly diagnosed SLE who developed methicillin-resistant Staphylococcus aureus (MRSA) purulent pericarditis. Despite broad-spectrum antibiotics and immunosuppressive therapy for multisystem lupus activity, the patient deteriorated rapidly due to MRSA-positive pericarditis.
In parallel with this index case, we systematically searched PubMed/MEDLINE, Google Scholar and ResearchGate for case reports and series of microbiologically confirmed septic or purulent pericarditis in SLE, from inception to March 2025 and updated through November 2025. Two reviewers independently screened studies; extracted relevant clinical, microbiologic, immunologic and outcome data; and synthesised findings descriptively.
Fifteen published culture-confirmed cases plus our index case were identified (total n=16). Most patients were female (93.8%), with a mean age of 34.1 years. Staphylococcus aureus (including MRSA) and Salmonella species predominated. Dyspnoea (68.8%) was more frequent than fever (31.3%) and nearly all patients progressed to cardiac tamponade requiring urgent drainage. Survival was 93.8% when timely pericardial drainage and pathogen-directed antimicrobial therapy were achieved, while routine serological markers failed to distinguish infection from lupus flare.
Septic pericarditis in SLE is uncommon but rapidly progressive. Early echocardiography and a low threshold for diagnostic pericardiocentesis are essential to prevent fatal delay.
Authors
Alamlih Alamlih, Neiroukh Neiroukh, Qawasmeh Qawasmeh, Rayyan Rayyan, Alamlih Alamlih, Doudin Doudin, Amro Amro, Abumounshar Abumounshar, Henahen Henahen
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