Manifestação rara de edema agudo de pulmão associado à miocardite lúpica aguda

Abstract

Systemic Lupus Erythematosus (SLE) is the most common systemic autoimmune disease, occurring more frequently in women, usually aged between 16 and 55 years 1, 2. Although classically the kidneys are the organs most affected in SLE, cardiopulmonary circulation and the heart may also be affected significantly 3. In this context, the occurrence of acute pulmonary edema associated with lupus myocarditis is rare and specific immunosuppressive therapy remains unclear.

Myocarditis with Cardiogenic Shock as the First Manifestation of Systemic Lupus Erythematosus

“…In general, patients with lupus myocarditis are usually asymptomatic, with symptoms present in only approximately 5 to 10% of patients. 3 However, severe heart failure may be the first manifestation of the disease.…”

“…Among all the markers, the presence of anti-DNA antibodies has been associated with lupus myocarditis. 3 An elevation in myocardial necrosis markers can occur; however, it is not related to clinical severity. 7 , 8 …”

“…Specific treatments for patients with severe left ventricular dysfunction associated with lupus myocarditis include high-dose corticosteroids; in some situations, such as in this patient, this involves pulse therapy with methylprednisolone, and other immunosuppressants (cyclophosphamide, azathioprine) or immunoglobuolins. 2 , 3 , 5 , 7 However, the currently used treatments are not supported by scientific findings from controlled studies, due to the difficulty in performing such studies because of the rarity of this kind of presentation.…”

“…An early and precise diagnosis allows the implementation of an aggressive treatment of lupus myocarditis and leads to better outcomes, including the resolution of left ventricular systolic dysfunction, which may occur in up to 89% of cases within 6 months, according to reports in the literature 3 . However, an episode of lupus myocarditis seems to be a marker of worse prognosis in patients with systemic lupus erythematosus.…”