Lupus Myocarditis Presenting as Global Heart Failure: Case Report

Context: Myocarditis is a rare but potentially life-threatening complication in patients with systemic lupus erythematosus (SLE). It involves inflammation of the cardiac muscle, which can lead to heart failure, arrhythmias, and myocardial dysfunction. Early recognition and appropriate management are crucial for improving outcomes.

Introduction: SLE is a systemic autoimmune disorder that can affect multiple organs, including the heart. While pericarditis is the most common cardiac manifestation, lupus myocarditis remains rare but poses significant risks. Its clinical presentation can overlap with other causes of heart failure, making diagnosis challenging. Imaging and biomarker evaluation are essential in ruling out other potential causes of cardiomyopathy.

Case Presentation: We report the case of a 51-year-old female with a 10-year history of SLE who presented with progressive dyspnea, peripheral edema, and global heart failure. Transthoracic echocardiography revealed severe hypokinetic cardiomyopathy with a left ventricular ejection fraction of 15%. Electrocardiogram (ECG) showed Q waves in the anteroseptal region and a left anterior fascicular block. Coronary angiography excluded significant obstructive coronary disease, and cardiac magnetic resonance imaging (MRI) suggested myocarditis. Lupus myocarditis was suspected based on the clinical findings and the exclusion of other causes.

Conclusion: Lupus myocarditis is a rare but important consideration in SLE patients presenting with heart failure. Early diagnosis, using noninvasive imaging and clinical exclusion of other causes, is essential for initiating timely treatment. Aggressive immunosuppressive therapy can stabilize the patient's condition, although residual cardiac dysfunction may persist. Further research is needed to refine diagnostic criteria and optimize therapeutic approaches for this condition.