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Robert J. Lerer, MD
New Haven, Conn

JAMA. 1973;223(1):81.

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To the Editor.—

I was interested in the report by Greenberg and Lutcher (22:191, 1972) describing a patient with suspected isoniazid-induced lupus erythematosus (LE) syndrome and pericardial tamponade. The authors advocate the use of steroids for this complication, and quote Dubois¹ as believing that LE patients with pericardial tamponade do not require pericardiocentesis, but should be treated exclusively with steroids.

In a recent short review of the literature on the subject of the management of pericardial effusions in LE (Am J Dis Child 124:436, 1972), I pointed to the considerable controversy surrounding this topic. There are several reports of failure of steroid therapy to reduce the size of pericardial effusions in LE; furthermore, massive effusion has occurred during administration of large doses of steroids.^2-4 Obviously, the approach to this problem needs to be individualized. Uncomplicated pericardial effusions should be treated with high doses of steroids and close monitoring . . . [Full Text PDF of this Article]

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