Myocarditis as the first sign of SLE: a case report and review of the literature.

Lupus myocarditis (LM) is a rare but potentially life threatening manifestation of systemic lupus erythematous (SLE). LM may be rarely the initial presentation of SLE or ma y be presented during the course of the disease. Herein, we report a case of an adult female patient who presented with a 3-day history of abdominal pain, fever and recent onset dyspnea on exertion. Twenty-four hours later the patient developed acute heart failure went into cardiac arrest during her transfer from the internal medicine department to the CT scanner. She was intubated, an intra-aortic balloon pump was inserted, and was transferred to the intensive care unit (ICU). Based on clinical signs, laboratory parameters and cardiac imaging and after the exclusion of other causes of acute heart failure LM was diagnosed. The patient received high doses of corticosteroids and cyclophosphamide and she was improved. The vasopressors were tapered off and the intra-aortic balloon pump was removed. The patient improved and she shifted out of the ICU. The initially increased troponin levels were decreased, while the ejection fraction increased to 60% five days later. The patient was followed as an outpatient after hospital discharge. At 6 months of follow-up the she was on treatment with low doses of oral steroids, hydroxychloroquine and azathioprine and her ejection fraction is 73% without signs of active disease. No recurrences of her LM have been observed during her 32 month follow-up. Prompt recognition and aggressive immunosuppressive treatment may lead to favourable prognosis.