Fatal Myopericarditis in a Patient With Lupus Erythematosus Supported by Extracorporeal Membrane Oxygenation: A Case Report

Lee, Soo Yong; Park, Ji Hye; Shin, Dong Hoon; Kim, Tae-Hwa; Lim, Seungjin

doi:10.4078/jrd.2021.28.3.165

Cited by 1 publication

(2 citation statements)

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“…Myocarditis remains rare but life-threatening with significant morbidity and mortality in 50% of cases, especially when it is present as an initial manifestation [5]. Few cases have presented with myocarditis complicated with cardiogenic shock associated with systemic lupus [2,[4][5][6][7]. Pleural and pericardial effusion occur in a large number of patients with myocarditis, and this was the case of our patient too.…”

Section: Discussionmentioning

confidence: 60%

“…Therefore, the search for extracardiac signs such as skin, joints, and kidney injuries can guide the etiological workup. Diagnostic workup must include a search for viral myocarditis, toxic or hypersensitivity-inducing drugs myocarditis, lupus myocarditis, other immune-mediated myocarditis (giant-cell myocarditis, or sarcoidosis, for example), and familial cardiomyopathy [7,10]. In that sense, patients with myocardial infarction and non-obstructive coronary arteries (MINOCA) represent an especially challenging population, especially on the etiological level, hence the difficulty to propose a proper therapy.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Mycophenolate Mofetil Use in Severe Myocarditis Complicating Systemic Lupus

Allaoui¹,

OUARRADI²,

Jabbouri³

et al. 2022

Cureus

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Cardiac involvement represents an increasingly frequent complication in systemic lupus, with pericarditis being the most classic cardiac manifestation. However, the most severe and fatal form seems to be myocarditis. We present the case of a patient with systemic lupus complicated by cardiogenic shock secondary to troponin-negative acute myopericarditis and successfully treated with mycophenolate mofetil and corticosteroid therapy. A 33-year-old woman with no past medical history presented with asthenia and inflammatory arthralgia. She was admitted in June 2021 for acute heart failure. Transthoracic cardiac ultrasound showed dilated cardiomyopathy with global hypokinesis (20-25% of ejection fraction) and right ventricular dysfunction without significant mitral and aortic valve disease. She had raised proBNP (probrain natriuretic peptide), low troponin, normochromic normocytic anemia at 10.4 g/dL, positive direct Coombs, lymphopenia at 460/mm 3 , serum creatinine at 23.9 mg/L, and proteinuria/creatininuria 2.48 g/g. Cardiac magnetic resonance imaging (CMR) suggested the diagnosis of myopericarditis. The etiological assessment did not identify an infectious, toxic, or medicinal cause. The clinical picture suggested the possibility of an autoimmune disease. The patient presented with lesions suggestive of cutaneous vasculitis, with oral ulcers with polyarthritis. The autoimmune workup showed anti-nuclear antibodies at 1:1,280, antinative DNA antibodies at 210 IU/mL (normal < 10 IU/mL), and positive anti-SM Abs. The diagnosis of lupus myopericarditis complicated by cardiogenic shock was made, which was associated with acute renal impairment. The patient was initiated on heart failure medications along with corticosteroids and mycophenolate mofetil. On day 15, the left ventricular ejection fraction improved to 45-50%, with clinical improvement in signs of heart failure and general condition. The existence of myopericarditis without obvious etiology, especially when there are extra-cardiac signs such as skin and joint involvement, should lead us to look for systemic lupus in order to start etiological treatment in addition to cardiac medical treatment. Until now, there is no standard treatment for lupus myocarditis, but the use of mycophenolate mofetil seems to be a promising treatment.

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