Successful extracorporeal membrane oxygenation for cardiac arrest and cardiogenic shock due to lupus myocarditis: a case report.

Background: Myocarditis due to systemic lupus erythematosus (SLE), also known as lupus myocarditis, is a rare but potentially life-threatening manifestation of this autoimmune disease. Although pericardial involvement is more commonly observed in SLE, myocarditis can occasionally lead to severe cardiac dysfunction and cardiogenic shock. Diagnosis can be challenging due to non-specific symptoms, and early recognition is crucial. Reports of cases requiring advanced circulatory support, such as venous-arterial extracorporeal membrane oxygenation (VA-ECMO), remain extremely limited in the literature. Case Description: We report the case of a 47-year-old woman with a known history of SLE who experienced sudden cardiac arrest at Osaka Keisatsu Hospital. Cardiopulmonary resuscitation was immediately initiated, and return of spontaneous circulation was achieved. Despite this, she remained in prolonged cardiogenic shock unresponsive to conventional therapy, prompting the initiation of VA-ECMO on the day of admission. Laboratory and imaging findings supported the diagnosis of lupus myocarditis and high-dose corticosteroid therapy was commenced promptly. Over the following days, her cardiac function gradually improved, and she was weaned off VA-ECMO on day 6. Remarkably, she demonstrated a full neurological recovery and was eventually discharged without significant sequelae. Conclusions: This case highlights the severe cardiac complications that can arise in patients with SLE, particularly the rare occurrence of myocarditis leading to cardiogenic shock. The timely use of VA-ECMO provided essential hemodynamic support, allowing for patient stabilization and further management. Early diagnosis, aggressive management, and multidisciplinary care are critical to achieving favorable outcomes in such complex cases.