Cardiac tamponade in systemic juvenile rheumatoid arthritis requiring emergency pericardiectomy.

A 9-year-old boy with systemic onset juvenile rheumatoid arthritis (JRA) presented with fever and chest pain and rapidly developed pericarditis and cardiac tamponade. Despite corticosteroid treatment and pericardiocentesis, rapid deterioration necessitated the emergency placement of a pericardial window. This is the first reported instance of this type of emergency surgical intervention for JRA. Of 220 children with JRA followed for 12 years (7% systemic onset), 8 had evidence of acute pericarditis but no other had definite evidence of tamponade.