Rare Presentation of Lupus Myocarditis With Acute Heart Failure—A Case Report

Malhotra, Gurveen; Chua, S. M.; Kodumuri, Vamsi; Sivaraman, Sivashankar; Ramdass, Priya

doi:10.1097/mjt.0000000000000295

Cited by 9 publications

(3 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, due to the clinical manifestations and the diagnosis of SLE by clinical and immunological criteria, the diagnosis of lupus myocarditis was considered. Previous cases have been documented of SLE patients who developed acute heart failure postpartum, where a misdiagnosis of peripartum cardiomyopathy led to adverse outcomes (10,11). Peripartum cardiomyopathy is an idiopathic disease that manifests as heart failure at the end of pregnancy or in the early postnatal period.…”

Section: Discussionmentioning

confidence: 99%

Cardiogenic Shock in Puerperal Patient: Uncommon Immunological Complication a Case Report and Literature Review

Marenco,

Mercado,

Montoya-Rodríguez

2024

Preprint

View full text Add to dashboard Cite

A 34-year-old woman with a history of chronic hypertension and two previous cesarean sections presented with symptoms of preeclampsia and fetal growth restriction in her 35th week of pregnancy. The condition progressed to preterm labor, resulting in an emergency cesarean section. Two weeks postpartum, she developed fever, dyspnea, and joint pain. Investigation revealed cardiomegaly, pulmonary edema, and severe ventricular dysfunction. Laboratory tests confirmed autoimmune markers consistent with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). She was diagnosed with acute myocarditis related to SLE/APS and managed with inotropic support, diuretics and immunosuppression. Left ventricular function improved, and she was discharged with ongoing rheumatologic follow-up. This case highlights the complex interplay between peripartum complications, autoimmune diseases, and cardiac involvement, emphasizing the importance of early diagnosis and multidisciplinary management.

show abstract

Section: Discussionmentioning

confidence: 99%

Cardiogenic Shock in Puerperal Patient: Uncommon Immunological Complication a Case Report and Literature Review

Marenco,

Mercado,

Montoya-Rodríguez

2024

Preprint

View full text Add to dashboard Cite

show abstract

“…In most cases, pulse corticosteroids followed by cyclophosphamide have been effective in lupus myocarditis management [8]. 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.…”

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

“…Se caracteriza en muchos casos como vasculitis de vasos pequeños y trombosis, raramente identificable como manifestación inicial del cuadro, aunque potencialmente fatal. [7][8][9][10] Se cuenta con escasa literatura sobre las manifestaciones clínica acompañantes y evolución final de dichos casos de miocardiopatía lúpica temprana. Presentamos el caso de una mujer de 31 años que debuta con miocarditis grave por lupus, con deterioro cardiogénico cuyo cuadro clínico inicia con dolor torácico compatible con un infarto agudo de miocardio tipo II.…”

Section: Discussionunclassified

Miocarditis como manifestación inicial de Lupus Eritematoso Sistémico: Reporte de caso

Triminio¹,

Aguilar²,

Rodríguez³

2020

RMH

View full text Add to dashboard Cite

Antecedentes: El Lupus Eritematoso Sistémico es una enfermedad autoinmune, sistémica, que involucra diferentes órganos incluyendo el corazón. Una de las manifestaciones cardíacas más comunes es la pericarditis; sin embargo, también se pueden presentar otras formas de afectación cardiaca entre las que se incluye la enfermedad arterial coronaria, arteritis y enfermedad valvular. Una de las presentaciones raras del lupus eritematoso sistémico incluye la miocarditis y una vez sospechada, debe ser diagnosticada y tratada con prontitud para evitar consecuencias fatales para el paciente. Descripción del caso: Presentamos un caso de una paciente femenina de 31 años con historia de dolor torácico, fiebre, fatiga, alteraciones ecocardiográficas y niveles elevados de troponina, a quien se le diagnóstico miocarditis y confirmación de Lupus Eritematoso Sistémico. El manejo fue terapia anti-isquémica e inmunoreguladores, con respuesta terapéutica y evolución satisfactoria. Conclusión: La miocardiopatía clínicamente evidente rara vez es la manifestación inicial de Lupus Eritematoso Sistémico, aunque también puede presentarse en el curso de la enfermedad con disfunción ventricular izquierda, insuficiencia cardiaca aguda y edema pulmonar, es de progresión rápida y requiere de diagnóstico y atención temprana, manejo multidisciplinario para evitar complicaciones fatales.

show abstract

Rare Presentation of Lupus Myocarditis With Acute Heart Failure—A Case Report

Cited by 9 publications

References 18 publications

Cardiogenic Shock in Puerperal Patient: Uncommon Immunological Complication a Case Report and Literature Review

Cardiogenic Shock in Puerperal Patient: Uncommon Immunological Complication a Case Report and Literature Review

Mycophenolate Mofetil Use in Severe Myocarditis Complicating Systemic Lupus

Miocarditis como manifestación inicial de Lupus Eritematoso Sistémico: Reporte de caso

Contact Info

Product

Resources

About