Perimyocarditis With Acute Heart Failure as the First Manifestation of Systemic Lupus Erythematosus

Abstract

Cardiac abnormalities are common in patients with systemic lupus erythematosus (SLE). However, many of them tend to be mild or asymptomatic and can be recognized by non-invasive studies such as transthoracic echocardiography and cardiac magnetic resonance imaging (CMR). However, heart failure secondary to perimyocarditis as the initial manifestation of SLE remains an extremely rare form of presentation. Below, we present the case of an adult female patient who initially consulted due to symptoms of acute dyspnea, atypical chest pain, and edema of the lower limbs, who underwent a chest X-ray as part of the initial studies, which described an increase in the cardiac silhouette associated with diffuse opacities in both lung fields. The admission electrocardiogram only showed sinus tachycardia and nonspecific alterations of the T wave, with an initial report of frankly elevated cardiac biomarkers compatible with acute myocardial injury together with the positivity of specific antibodies for SLE.

Case report: Severe sinus tachycardia as a leading manifestation of systemic lupus erythematosus flare

“…Cardiac involvement in SLE is not limited to arrhythmias. Santacruz et al (10) reported a case of a 40-year-old female who presented with tachycardia, acute dyspnea, and atypical chest pain. ECG was only significant for sinus tachycardia and non-specific T wave changes.…”

“…Her hospital course included acute renal impairment, proteinuria, left atrial thrombus, and peri-myocarditis diagnosis. Further workup led to a diagnosis of SLE, which was thought to be the culprit (10).…”