Description Myocarditis is a rare presentation of systemic lupus erythematosus (SLE) and its diagnosis can be challenging as its non-specific clinical presentation varies greatly from being asymptomatic to life-threatening. Nonetheless, prompt and early identification of lupus myocarditis can reduce morbidity and mortality. Timely administration of high dose corticosteroids may pose favorable outcome for the patient. This paper aims to present a case of 43-year-old female who presented with polyarthritis, shortness of breath, intermittent fever and orthopnea. Diagnostics revealed pancytopenia, positive direct Coombs test, elevated LDH, proteinuria and hematuria. Chest radiographs and computed tomography showed alveolar edema. The initial 2D echocardiography showed low ejection fraction (EF) of 35% by Simpson with depressed systolic function, global hypokinesia with normal left ventricular dimensions, left atrial size, and volume index. Her ANA is positive with homogenous pattern hence was diagnosed with acute lupus myocarditis. She was admitted at the intensive care unit and was intubated. She received methylprednisolone pulse therapy with guidelines directed medical therapy for heart failure. Repeat 2D echocardiography a day after pulse therapy showed marked improvement of systolic function with EF of 66% by Simpson, adequate wall motion, contractility, systolic, and diastolic function. She had full recovery and returned to her normal function after one month.
Conclusions Timely diagnosis and prompt initiation of treatment for Lupus Myocarditis by giving high dose steroids together with guidelines directed medical therapy for heart failure led to favorable clinical outcomes.
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