Case 1: A 35-year-old woman of Hispanic ancestry A 35-year-old woman of Hispanic ancestry received a diagnosis of systemic lupus erythematosus (SLE) in June 2021, based on polyarthralgia/itis, malar rash, proteinuria of 1400 mg/24 h, positive antinuclear antibodies, anti-double-stranded DNA antibodies (anti-dsDNA), with hypocomplementemia. Lupus anticoagulant, anticardiolipin and anti-β₂-Glycoprotein-I antibodies were negative. Her SLEDAI score was 16. A kidney biopsy was performed showing a focal proliferative glomerulonephritis (Class III), with a score of 12 and 0 of activity and chronicity, respectively. She was treated with hydroxychloroquine 400 mg/day, prednisone 20 mg/day, and mycophenolate mofetil 3000 mg/day as induction therapy.

In September 2021 she came to the emergency room due to persistent tachycardia, dyspnea on moderate exertion, and chest pain. At admission she presented elevated ESR and C-reactive protein level, normal kidney function tests, proteinuria of 350 mg/24 h, and positive anti-dsDNA, with low C3 and C4. During hospitalisation she presented fever, and worsening dyspnea, for which she required oxygen therapy. The electrocardiogram showed sinus tachycardia and the echocardiography a systolic dysfunction and a hypokinetic left ventricle (inferior and lateral walls) with an ejection fraction of 40%. Troponin T and brain natriuretic peptides were elevated. The SARS-CoV2 RT-PCR was positive. With the suspected diagnosis of acute myocarditis in the context of SARS-CoV2 infection, the patient was treated with methylprednisolone pulses, IVIG, and respiratory support.

Learning Objectives

• Describe the different myocardial manifestations in a patient with SLE.

• Discuss complications and differential diagnosis with allied diseases.

• Discuss the treatment of myocarditis in a patient with SLE.