DOI: https://doi.org/10.36347/sjmcr.2026.v14i05.085

Pages: 1218-1222

Introduction: Systemic lupus erythematosus (SLE) associated with antiphospholipid syndrome (APS) significantly increases cardiovascular risk. While pericarditis is common in SLE, progression to inaugural cardiac tamponade is exceptional. The simultaneous occurrence of tamponade and pulmonary embolism (PE) as the primary manifestation is extremely rare. Case Presentation: A 41-year-old female with a history of spontaneous abortions was admitted for obstructive shock and respiratory distress. Echocardiography revealed a large pericardial effusion with marked right chamber dilation. Following life-saving pericardiocentesis (900 ml), persistent hypoxemia led to the diagnosis of proximal PE via CT angiography. Laboratory tests confirmed an SLE-APS overlap syndrome. The patient was successfully managed through therapeutic sequencing: pericardial drainage, followed by cautious anticoagulation and high-dose corticosteroid therapy. Conclusion: This case highlights an "inverted echocardiographic phenotype" where pulmonary hypertension masks the typical right chamber collapse of cardiac tamponade. A sequential and multidisciplinary approach is essential to address this dual mechanical and thrombotic obstruction.