Lupus myocarditis-A rare case

Mohanty, Bijaya; Sunder, Ashok

doi:10.4103/jfmpc.jfmpc_716_20

Cited by 7 publications

(5 citation statements)

References 17 publications

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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: 59%

“…The pathogenesis is thought to be in theory mediated by immune complex formation and complement activation [4,9]. Other contributing factors such as accelerated atherosclerosis, infections, antiphospholipid antibodies, and drugs such antimalarials were also described [9][10].…”

Section: Discussionmentioning

confidence: 99%

“…Other forms are also known for their severity and mortality rate, such as the occurrence of myocarditis, which occurs in 10% of cases in some autopsy series [2]. Postmortem findings from some cases have reported a higher prevalence of 50-60%, indicating a high prevalence of subclinical disease [3,4]. We present here the case of a patient with systemic lupus, which was revealed by cardiogenic shock on troponin-negative acute myopericarditis and successfully treated with mycophenolate mofetil and corticosteroid therapy.…”

Section: Introductionmentioning

confidence: 91%

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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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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 91%

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Mycophenolate Mofetil Use in Severe Myocarditis Complicating Systemic Lupus

Allaoui¹,

OUARRADI²,

Jabbouri³

et al. 2022

Cureus

View full text Add to dashboard Cite

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“…Systemic lupus erythematosus (SLE) manifests in various cardiovascular complications, encompassing pericarditis, cardiomyopathy, valvular dysfunction, coronary artery disease, conduction defects, thromboembolism, and myocarditis. While myocarditis is relatively rare in SLE, with a clinical prevalence of approximately 3-9%, its implications are severe, demanding vigilant clinical management due to the potential for lethal complications 4 . There exist reports of heart failure and acute myocarditis as the initial presentations of SLE, posing diagnostic challenges.…”

Section: Discussionmentioning

confidence: 99%

Lupus Myocarditis with Pericardial Effusion: a Rare Presentation of Systemic Lupus Erythematosus

Khalid,

Hashmi,

Akhtar

2024

Pak Heart J

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Systemic lupus erythematosus (SLE) can manifest with diverse cardiac presentations, with pericarditis being the most common. However, myocarditis, albeit rare, poses significant risks. Here, we present the case of a 20-year-old woman initially diagnosed with tuberculosis but later found to have lupus myocarditis, a rare complication of SLE. She presented with features of left ventricular failure and pericardial effusion, demonstrating the importance of considering alternative diagnoses in such cases. Prompt management with supportive care and oral steroids led to eventual improvement.

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“…The cardiac involvement of systemic lupus erythematosus (SLE) with refractory shock is rare and life-threatening [ 1 , 2 ]. Lupus myocarditis (LM) is clinically found in 3%∼9% of SLE patients [ 3 ]. Herein, we report a challenging diagnosis, which was obtained by myocardial biopsy, and the treatment of a patient with SLE who presented with cardiogenic shock.…”

Section: Introductionmentioning

confidence: 99%

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

Lee

Park²,

Shin

et al. 2021

J Rheum Dis

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Systemic lupus erythematosus (SLE) may occur in any organ. In patients with SLE, myocarditis is extremely rare and potentially life-threatening. Herein, we report on a patient with lupus myocarditis, diagnosed by myocardial biopsy, immunologic tests, and clinical manifestations. Our findings suggest that securing time for diagnosis via extracorporeal membrane oxygenation and other intensive care is helpful for obtaining a good prognosis.

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Lupus myocarditis-A rare case

Abstract: Myocarditis in patients of systemic lupus erythematosus is extremely rare and is potentially life threatening. This may be the first presentation of the disease. Here, we report a patient who presented with features of heart failure and was later diagnosed to have SLE.

Cited by 7 publications

References 17 publications

Mycophenolate Mofetil Use in Severe Myocarditis Complicating Systemic Lupus

Mycophenolate Mofetil Use in Severe Myocarditis Complicating Systemic Lupus

Lupus Myocarditis with Pericardial Effusion: a Rare Presentation of Systemic Lupus Erythematosus

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

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