Sinus node disfunction in an adolescent with systemic lupus erythematosus

Abstract

Cardiac involvement in systemic lupus erythematosus (SLE) is well documented. The pericardium, myocardium and endocardium, as well as the coronary arteries, the valves and the conduction system can all be affected. While pericarditis is common, arrythmias are less frequently described. We present a 13-year-old male, who had fatigue, anorexia, weight loss, myalgias and arthralgias for four months. On physical examination, we identified bradycardia (heart rate 31–50 bpm), oral and nasal ulcers and polyarthritis. The laboratory results showed hemolytic anemia, hypocomplementemia, antinuclear and anti-dsDNA antibodies, hematuria and non-nephrotic proteinuria. Renal function was normal. Lupus nephritis class II was diagnosed by kidney biopsy. On the transthoracic echocardiogram we identified a minimal pericardial effusion, suggesting pericarditis, and, on the electrocardiogram, we detected sinus arrest with junctional rhythm, denoting sinus node dysfunction. The patient was diagnosed with juvenile SLE with cardiac, renal, musculoskeletal and hematologic involvement. Disease remission and cardiac rhythm control were obtained with steroids and mycophenolate mofetil. Currently, the patient is asymptomatic, with normal sinus rhythm. We described an adolescent with SLE who had sinus node dysfunction upon diagnosis. Other cases have been reported in adults but none in juvenile SLE. All SLE patients should have a thorough cardiac examination to promptly diagnose and treat the innumerous cardiac manifestations of this disease.

Sinus Node Dysfunction and Acute Transverse Myelitis As Initial Presentation of Systemic Lupus Erythematosus in a 55-Year-Old Female: A Case Report

“…However, it could present as sinus bradycardia, sinus pause with junctional rhythm, sino-atrial block, chronotropic incompetence, and alternating bradycardia and tachycardia episodes (bradycardia-tachycardia syndrome) [ 7 ]. Case reports have been documented on SLE presenting with SND, but pertinent in all their profiles were the associated symptoms of fever, myalgia, arthralgia/arthritis, photosensitivity, malar rash, oral ulcers, and hair loss, leading to high suspicion for lupus [ 7 , 8 ]. SND with severe bradycardia in another report was noted to be associated with high disease activity [ 9 ].…”

“…Conduction system disorders, however, have less known prevalence and yet bear serious implications as these are frequent causes of sudden cardiac death among SLE patients [3][4][5]. While tachyarrhythmias have been determined in prevalence studies, bradyarrhythmias, particularly sinus node dysfunction (SND), remain less well known [4,[6][7]. In case reports described so far among SLE patients with SND, most have associated systemic symptoms such as fever, and myalgia, and its occurrence is likewise associated with a high disease activity [7][8][9].…”

“…While tachyarrhythmias have been determined in prevalence studies, bradyarrhythmias, particularly sinus node dysfunction (SND), remain less well known [4,[6][7]. In case reports described so far among SLE patients with SND, most have associated systemic symptoms such as fever, and myalgia, and its occurrence is likewise associated with a high disease activity [7][8][9]. Despite the largely undetermined mechanisms behind arrhythmias in SLE, sustained SND is managed with pacemaker insertion [8,10].…”