Heart Failure - A Rare Initial Manifestation of Systemic Lupus Erythematosus

Abstract

1.1 Context Cardiac involvement is a leading cause of death in systemic lupus erythematosus (SLE). Heart failure (HF) is a potentially life threatening complication of lupus myocarditis which is rarely described as an initial manifestation of SLE. We are presenting a case of HF as initial manifestation of SLE. 1.2 Case description 49 year old male with no past medical history presented with dyspnea and generalized weakness of 6 weeks duration. Physical exam was remarkable for tachycardia, S3 gallop, bibasilar crackles, and 2+ pitting edema. Echocardiogram showed ejection fraction of 35% without regional wall motion abnormalities or pericardial effusion. Cardiac catheterization showed normal coronaries. Serological tests indicated positive ANA, Anti-smooth muscle, SCL-70 and SSA antibodies. Patient was given methyl prednisone 1 g/day for 3 days followed by tapering dose of oral prednisone in addition to intravenous furosemide. He was discharged on prednisone 40 mg, hydroxychloroquine 200mg in addition to B-Blockers and ACE inhibitors. On follow up evaluation after 4 weeks there was complete resolution of his symptoms with improvement in ejection fraction to 45%. 1.3 Conclusion HF due to myocarditis can be a rare initial presenting manifestation of SLE. Identifying the cause is critical as it dictates therapy. Prompt recognition and a combination of supportive treatment and immunosuppression usually results in a favorable outcome.