Systemic lupus erythematosus (SLE) in adolescents often presents more severely than in adults, with common complications including lupus nephritis (LN) and less frequently cardiac involvement such as pericarditis. Early recognition and treatment of these manifestations are critical, especially in resource limited settings where diagnostic and therapeutic delays can worsen the outcomes.

We report the case of a 16 year old Bangladeshi girl with previously diagnosed SLE who presented with highgrade fever, fatigue, generalised edema, and pleuritic chest pain, and was diagnosed with SLE complicated by severe LN and a large lupus pericardial effusion. One year earlier, she had manifested with fever, rash, arthritis, oral ulcers, and renal involvement with serological confirmation of the diagnosis and responded well to corticosteroids and immunosuppressive therapy. On current presentation, examination revealed hypertension with bilateral pitting edema and signs of pericardial effusion (raised jugular venous pressure, distant heart sounds, and a pericardial friction rub), alongside anaemia but no active skin rash or arthritis. Echocardiography demonstrated a large pericardial effusion (~28 mm) with early features of cardiac tamponade. Due to financial constraints and urgent clinical need, invasive procedures were deferred. The patient was managed for a lupus flare with high dose corticosteroids, mycophenolate mofetil, and hydroxychloroquine, along with supportive care for cardiorenal syndrome resulting in marked clinical improvement and complete resolution of the effusion without invasive intervention. She was discharged on maintenance immunosuppression after showing marked improvement for a week. However, socioeconomic factors have impeded regular followup; at last telephone contact, she remains clinically stable on treatment.