In systemic scleroderma, pericardial involvement is usually silent and benign. Symptomatic pericarditis is rare and cardiac tamponade even more so. We report the case of a 56-year-old woman presenting with cardiac tamponade and whose etiologic investigation concluded to a final diagnosis of limited cutaneous systemic scleroderma. Clinicians should be wary of this diagnosis when dealing with acute-onset pericarditis.