Hemorrhagic Tamponade as Initial Manifestation of Systemic Lupus with Subsequent Refractory and Progressive Lupus Myocarditis Resulting in Cardiomyopathy and Mitral Regurgitation

Marijanovich, Nicole; Halalau, Alexandra

doi:10.1155/2018/7635982

Cited by 6 publications

(5 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Fungal (e.g., Histoplasma capsulatum ) and parasitic infections (e.g., Wuchereria bancrofti ) are also potential etiological factors but are less common [ 12 , 13 ]. Autoimmune conditions like rheumatoid arthritis and systemic lupus erythematosus are linked with HPE in the medical literature [ 14 , 15 ]. HPE is seldom the initial manifestation of autoimmune diseases, and the absence of associated symptoms like skin, joint, or mucosal signs or involvement of other extracardiac organs should not exclude the consideration of an autoimmune etiology.…”

Section: Discussionmentioning

confidence: 99%

Hemopericardium: A Comprehensive Clinical Review of Etiology and Diagnosis

Borkowski,

Borkowska,

Nazarenko

et al. 2024

Cureus

View full text Add to dashboard Cite

Hemorrhagic pericardial effusion (HPE) is a subtype of pericardial effusion marked by the accumulation of serosanguineous or bloody fluid within the pericardial cavity. We present a case of a 65-year-old female who presented to the hospital with abdominal pain and was found to have pericardial effusion. The patient’s condition evolved into cardiac tamponade, and employing diagnostic techniques such as imaging and pericardiocentesis, a substantial bloody effusion was uncovered, indicative of HPE. This report underscores the complexity of HPE diagnosis and examines the non-iatrogenic etiological factors contributing to HPE, focusing on three primary causes: malignancy, infection, and autoimmune disorders. It offers a detailed exploration of each etiology, backed by current medical literature and case studies. It outlines the diagnostic strategies pertinent to each cause, underscoring the need for a tailored approach to manage such cases. It emphasizes the importance of a meticulous and individualized diagnostic process, vital for accurate identification and effective management of this condition.

show abstract

Section: Discussionmentioning

confidence: 99%

Hemopericardium: A Comprehensive Clinical Review of Etiology and Diagnosis

Borkowski,

Borkowska,

Nazarenko

et al. 2024

Cureus

View full text Add to dashboard Cite

show abstract

“…it is suggested that this should be 0.5-1mg/kg of prednisone with a stable dose for a month, followed by slow tapering [29]Treatment of lupus myocarditis consists of corticosteroids in high doses (0.5-1mg/kg of prednisone or intravenous pulses of methylprednisolone, e.g. 1000mg/day for 3 consecutive days) in combination with immunosuppressives [25] Cyclophosphamide and intravenous immunoglobulins (IVIGs) have been shown to improve cardiac function and mortality [30] Ischemic cardiomyopathy should be treated with optimization of antiplatelet/ anticoagulant therapy and supportive measures (angiotensin converting enzyme inhibitors/receptor blockers, beta-blockers, diuretics etc. [31] Our patient was treated with corticosteroid therapy at a high dose of 60 mg / day with adjuvant treatment stopping plaquenil,a bolus of solumedrol with cyclophosphamide has been indicated after management of the infectious context of endocarditis in addition to the medical treatment of Heart failure…”

Section: Discussionmentioning

confidence: 99%

Peculiarity of Systemic Lupus Erythematosus with Cardiac Involvement in Case Report and Literature Review

El Abasse

2024

JCCI

View full text Add to dashboard Cite

Systemic lupus erythematosus (SLE, or lupus) is a condition in which the immune system attacks healthy cells and tissues throughout the body, it is characterized by aberrant activity of the immune system, leading to variable clinical symptoms. Case: A Moroccan 54 years old women presented a progressive dyspnea associated with palpitations with a history of hyperthyroidism, a pericardial effusion of great abundance punctured, the remainder of the diagnostic workup had revealed lupus erythematosus. The echocardiography found a global hypocontractility with an ejection fraction at 25%, a dilated atrial mass and mitral regurgtitaion, moderate aortic regurgitation with an image of vegetation on the non-coronary cusp, right ventricular dysfunction. Laboratory investigations revealed bycitopenia with high inflammatory markers, a renal dysfunction test result. Immunological tests showed a high positive antinuclear antibodies ans DNA antibodies. While hospitalization the patient presented a constrictive chest pain , the electrocardiogram showed an st segment elevation in the inferior derivation in relation with a coronary spasm.Three days later the patient presented a sudden neurological deficit type of right hemiparesis with facial paralysis and aphasia, the emergency MRI objectified a cortical frontotemporal stroke, in the acute phase, patient was thrombolysed by metalysis , finally the diagnosis of vasculitis of the central nervous system (CNS) was retained with ischemic and hemorrhagic lesions in favor of lupus vasculitis of the CNS . Discussion: Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that may affect several different organs(5) , the underlying pathophysiologic mechanism remains unknown, new autoantibodies, such as antibodies to DNA , antibodies to extractable nuclear antigens , and anticardiolipin antibodies, were recognized as causative of clinical subsets of lupus(5) SLE is an unpredictable disease, it is characterized by alternating periods of remission and exacerbation and by a wide variety of clinical manifestations that may affect any organ. The case of our patient with SLE involved: cardiac type of lupus myopericadtitis in biventricular dysfunction with LVEF: 25%, , Normochromic normocytic anemia with positive coombs test and lymphopenia and thrombocytopenia ; lupus nephropathy satde IV ; Cerebral vasculitis. Cytopenias are common in patients with lupus, and moderate to severe lymphopenia is associated with high disease activity and organ damage. Up to 50% of patients with SLE have evidence of renal disease at presentation (10) Lupus end-stage kidney disease is associated with worse survival among dialysis and transplant patients. The risk for ischemic stroke is higher in patient with SLE. Stroke affects 3–20% of patients with SLE and usually occurs within the first 5 years of the diagnosis(13,14). The main Cardiovascular diseases of SLE are valvular heart diseases associated with Libman-Sacks disease lesions, sterile vegetations, serositis associated with pericardial disease. African-American patients are at increased risk for development of myocarditis(20); low ejection fraction is detected in the majority of the patients (25)Our patient had an ejection fraction around 25% . The most characteristic valvulopathy of SLE is Libman- Sacks endocarditis (LSE), which mainly affects the left cardiac valves (22) . Non-steroidal anti-inflammatory drugs (NSAIDs) are considered as the first choice in mild cases with minimal pericardial effusion (28) Corticosteroids should be used in refractory cases with or without antimalarials. Corticosteroids in combination with immunosuppressives (25) Cyclophosphamide and intravenous immunoglobulins (IVIGs) have been shown to improve cardiac function and mortality (30), in addition to the medical treatment of Heart failure. Conclusion: Diagnosis of SLE can be challenging and while several classification criteria have been posed, their utility in the clinical setting is still a matter of debate. Despite several agents shown to be efficacious in the treatment of SLE, the disease still poses significant morbidity and mortality risk in patients.

show abstract

“…Other medications were used with various effects, such as azathioprine, cyclosporine, intravenous immunoglobulins, plasma exchange [8,17], and rituximab [18]. In few cases, mycophenolate mofetil was used as an induction drug in some cases with success [19][20][21], and significant improvements were noted in left ventricular ejection fraction with an overall cardiac recovery even in patients not treated with cyclophosphamide. To confirm the efficacy of mycophenolate mofetil in myocarditis, more data are needed.…”

Section: Discussionmentioning

confidence: 99%

Mycophenolate Mofetil Use in Severe Myocarditis Complicating Systemic Lupus

Allaoui¹,

OUARRADI²,

Jabbouri³

et al. 2022

Cureus

View full text Add to dashboard Cite

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.

show abstract

Hemorrhagic Tamponade as Initial Manifestation of Systemic Lupus with Subsequent Refractory and Progressive Lupus Myocarditis Resulting in Cardiomyopathy and Mitral Regurgitation

Cited by 6 publications

References 7 publications

Hemopericardium: A Comprehensive Clinical Review of Etiology and Diagnosis

Hemopericardium: A Comprehensive Clinical Review of Etiology and Diagnosis

Peculiarity of Systemic Lupus Erythematosus with Cardiac Involvement in Case Report and Literature Review

Mycophenolate Mofetil Use in Severe Myocarditis Complicating Systemic Lupus

Contact Info

Product

Resources

About