Abstract
A 47-year-old woman presented at her family physician complaining mainly of dyspnea and was admitted to our hospital with a diagnosis of acute cardiac failure. Cardiac failure did not improve despite oxygen therapy, diuretics, and other treatment; her condition deteriorated rapidly and she entered a state of shock. She was placed on a respirator and received assisted circulation via intra-aortic balloon pumping. A diagnosis of systemic lupus erythematosus (SLE) was made, based on the presence of leukocytopenia, positive anti-nuclear antibody, positive anti-ds-DNA, and arthritis. As SLE-associated cardiac lesions were suspected, steroid pulse therapy and oral methylprednisolone administration (50 mg/day) were started, and her medical condition quickly recovered. Myocardial biopsy revealed marked fibrosis among the cardiac muscle cells with no inflammatory cell invasion of the myocardium, establishing a diagnosis of acute cardiomyopathy caused by SLE.
Pericarditis, myocarditis, and cardiomyopathy are all recognized as SLE-associated cardiac lesions. We herein report this case, firstly because SLE rarely presents initially with the onset of acute severe cardiomyopathy, as occurred in this case, and secondly, in view of this rarity, we consider that this case is educational for both primarycare physicians and specialists alike.
