Abstract
BackgroundMyocarditis is an uncommon manifestation of systemic lupus erythematosus in which the clinical presentation can range from subclinical to life-threatening. We report cases of two patients who presented to our hospital with myocarditis as an initial manifestation of systemic lupus erythematosus despite negative results of extensive workup that excluded other diagnoses. The mainstays of treatment are corticosteroids, immunosuppressive agents, and anti-heart failure medications, with use of the latter being case-specific. Mycophenolate mofetil was the cornerstone of the proposed treatment for induction of remission, although it is well known to be used as a maintenance therapy in lupus myocarditis.Case presentationBoth Emirati patients described satisfied the diagnostic criteria for mixed connective tissue disease (systemic lupus predominant) and systemic lupus erythematous. Other differential diagnoses of myocarditis were excluded. The patients were started on pulsed steroid followed by oral steroid, with hydroxychloroquine, mycophenolate mofetil, and anti-heart failure medications used as needed. Dramatic responses were noted in the first few weeks in terms of symptoms.ConclusionEarly recognition and treatment of lupus myocarditis is needed to avoid fatal consequences.
Highlights
Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease with cardiac involvement in up to 50% of cases [1]
The clinical presentation of myocarditis in SLE ranges from asymptomatic patients with self-limited disease to fulminant heart failure that can lead to death
The findings indicate dilated cardiomyopathy with previous myocarditis
Summary
Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease with cardiac involvement in up to 50% of cases [1]. Patient 1 Patient 1 was a 41-year-old Emirati woman who was a housewife with known hypertension, hypothyroidism, and asthma She presented to our hospital with a 1-month history of fever associated with chills, rigors, pleuritic chest pain, pain in the small joints of the hand, cold in the extremities, and photosensitivity. She was noted to have a 1-year history of progressive fatigue, arthralgia, 20-kg weight loss, and intermittent low- and high-grade fever. Cardiac examination showed normal heart sounds without murmur. Laboratory investigations revealed normal complete blood count and renal and liver function test results, Fig. 1 Cardiac magnetic resonance imaging showing subepicardial late gadolinium enhancement of the basal inferior, anteroseptal, and inferoseptal segments. The findings indicate dilated cardiomyopathy with previous myocarditis (not active anymore, indicated by lack of myocardial edema)
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