Myocarditis as a lupus challenge: two case reports

• Published in: Journal of medical case reports 2019-11, Vol.13 (1), p.343-343, Article 343
• Main Authors: Al-Nokhatha, Shamma Ahmad, Khogali, Hiba Ibrahim, Al Shehhi, Maryam Abdulla, Jassim, Imad Tarik
• Format: Article
• Language: English
• Subjects: Adrenal Cortex Hormones - therapeutic use; Adult; Care and treatment; Case Report; Case reports; Corticosteroid drugs; Edema; Electrocardiography; Family medical history; Female; Heart; Heart failure; Humans; Hydroxychloroquine; Hydroxychloroquine - therapeutic use; Hypertension; Immunoglobulins; Immunology; Immunosuppressive agents; Immunosuppressive Agents - therapeutic use; Laboratories; Lupus; Lupus erythematosus; Lupus Erythematosus, Systemic - complications; Lupus Erythematosus, Systemic - drug therapy; Lupus Erythematosus, Systemic - pathology; Mixed connective tissue disease; Mycophenolate mofetil; Mycophenolic Acid - therapeutic use; Myocarditis; Myocarditis - diagnostic imaging; Myocarditis - etiology; Myocarditis - pathology; NMR; Nuclear magnetic resonance; Patient satisfaction; Patients; Systemic lupus erythematosus; Treatment Outcome
• ISSN: 1752-1947; 1752-1947
• DOI: 10.1186/s13256-019-2242-1

Myocarditis 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. Both 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. Early recognition and treatment of lupus myocarditis is needed to avoid fatal consequences.