Systematic review of culture-confirmed septic pericarditis in systemic lupus erythematosus with an index case
Abstract
Objective: 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.
Case presentation: 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.
Methods: 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.
Results: 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…
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 16 participants or records.
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