Systemic sclerosis presenting as recurrent pericardial effusion despite repeatedly negative multiplex antinuclear antibody results.
Tsubasa Omae, Kazuya Nagao, Sohei Funakoshi et al.
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Case in brief
A woman in her 70s presented multiple times with recurrent pericardial effusions, despite negative multiplex antinuclear antibody (ANA) results. A detailed history revealed Raynaud's phenomenon and abdominal bloating, leading to further testing. Indirect immunofluorescence confirmed ANA positivity and anti-RNA polymerase III antibodies, diagnosing systemic sclerosis. Treatment with colchicine prevented further effusions.
Diagnostic / clinical pearl
Clinicians should not rely solely on multiplex ANA screens; persistent clinical suspicion warrants further testing with HEp-2 indirect immunofluorescence and disease-specific antibodies.
Why it matters
This case highlights the importance of comprehensive evaluation in patients with unexplained pericardial effusions, as initial tests may not capture underlying autoimmune conditions.