Myocarditis as a lupus challenge: two case reports
Identifieur interne : 000610 ( Main/Merge ); précédent : 000609; suivant : 000611Myocarditis as a lupus challenge: two case reports
Auteurs : Shamma Ahmad Al-Nokhatha ; Hiba Ibrahim Khogali ; Maryam Abdulla Al Shehhi ; Imad Tarik JassimSource :
- Journal of Medical Case Reports [ 1752-1947 ] ; 2019.
Abstract
Myocarditis is an uncommon manifestation of systemic lupus erythematosus in which the clinical presentation can range from subclinical to life-threatening. We report cases of two patients who presented to our hospital with myocarditis as an initial manifestation of systemic lupus erythematosus despite negative results of extensive workup that excluded other diagnoses. The mainstays of treatment are corticosteroids, immunosuppressive agents, and anti-heart failure medications, with use of the latter being case-specific. Mycophenolate mofetil was the cornerstone of the proposed treatment for induction of remission, although it is well known to be used as a maintenance therapy in lupus myocarditis.
Both Emirati patients described satisfied the diagnostic criteria for mixed connective tissue disease (systemic lupus predominant) and systemic lupus erythematous. Other differential diagnoses of myocarditis were excluded. The patients were started on pulsed steroid followed by oral steroid, with hydroxychloroquine, mycophenolate mofetil, and anti-heart failure medications used as needed. Dramatic responses were noted in the first few weeks in terms of symptoms.
Early recognition and treatment of lupus myocarditis is needed to avoid fatal consequences.
Url:
DOI: 10.1186/s13256-019-2242-1
PubMed: 31744544
PubMed Central: 6864968
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We report cases of two patients who presented to our hospital with myocarditis as an initial manifestation of systemic lupus erythematosus despite negative results of extensive workup that excluded other diagnoses. The mainstays of treatment are corticosteroids, immunosuppressive agents, and anti-heart failure medications, with use of the latter being case-specific. Mycophenolate mofetil was the cornerstone of the proposed treatment for induction of remission, although it is well known to be used as a maintenance therapy in lupus myocarditis.</p></sec><sec><title>Case presentation</title><p id="Par2">Both Emirati patients described satisfied the diagnostic criteria for mixed connective tissue disease (systemic lupus predominant) and systemic lupus erythematous. Other differential diagnoses of myocarditis were excluded. The patients were started on pulsed steroid followed by oral steroid, with hydroxychloroquine, mycophenolate mofetil, and anti-heart failure medications used as needed. Dramatic responses were noted in the first few weeks in terms of symptoms.</p></sec><sec><title>Conclusion</title><p id="Par3">Early recognition and treatment of lupus myocarditis is needed to avoid fatal consequences.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Thomas, G" uniqKey="Thomas G">G Thomas</name></author><author><name sortKey="Cohen Aubart, F" uniqKey="Cohen Aubart F">F Cohen Aubart</name></author><author><name sortKey="Chiche, L" uniqKey="Chiche L">L Chiche</name></author><author><name sortKey="Haroche, J" uniqKey="Haroche J">J Haroche</name></author><author><name sortKey="Hie, M" uniqKey="Hie M">M Hié</name></author><author><name sortKey="Hervier, B" uniqKey="Hervier B">B Hervier</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Shinkawa, Y" uniqKey="Shinkawa Y">Y Shinkawa</name></author><author><name sortKey="Yagita, M" uniqKey="Yagita M">M Yagita</name></author><author><name sortKey="Fujita, M" uniqKey="Fujita M">M Fujita</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Zawadowski, G" uniqKey="Zawadowski G">G Zawadowski</name></author><author><name sortKey="Klarich, K" uniqKey="Klarich K">K Klarich</name></author><author><name sortKey="Moder, K" uniqKey="Moder K">K Moder</name></author><author><name sortKey="Edwards, W" uniqKey="Edwards W">W Edwards</name></author><author><name sortKey="Cooper, L" uniqKey="Cooper L">L Cooper</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Zhang, L" uniqKey="Zhang L">L Zhang</name></author><author><name sortKey="Zhu, Yl" uniqKey="Zhu Y">YL Zhu</name></author><author><name sortKey="Li, Mt" uniqKey="Li M">MT Li</name></author><author><name sortKey="Gao, N" uniqKey="Gao N">N Gao</name></author><author><name sortKey="You, X" uniqKey="You X">X You</name></author><author><name sortKey="Wu, Qj" uniqKey="Wu Q">QJ Wu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Woo, S" uniqKey="Woo S">S Woo</name></author><author><name sortKey="Hwang, G" uniqKey="Hwang G">G Hwang</name></author><author><name sortKey="Kang, S" uniqKey="Kang S">S Kang</name></author><author><name sortKey="Park, J" uniqKey="Park J">J Park</name></author><author><name sortKey="Park, S" uniqKey="Park S">S Park</name></author><author><name sortKey="Lee, Y" uniqKey="Lee Y">Y Lee</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Baquero, G" uniqKey="Baquero G">G Baquero</name></author><author><name sortKey="Banchs, J" uniqKey="Banchs J">J Banchs</name></author><author><name sortKey="Naccarelli, G" uniqKey="Naccarelli G">G Naccarelli</name></author><author><name sortKey="Gonzalez, M" uniqKey="Gonzalez M">M Gonzalez</name></author><author><name sortKey="Wolbrette, D" uniqKey="Wolbrette D">D Wolbrette</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Appenzeller, S" uniqKey="Appenzeller S">S Appenzeller</name></author><author><name sortKey="Pineau, C" uniqKey="Pineau C">C Pineau</name></author><author><name sortKey="Clarke, A" uniqKey="Clarke A">A Clarke</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Perel Winkler, A" uniqKey="Perel Winkler A">A Perel-Winkler</name></author><author><name sortKey="Bokhari, S" uniqKey="Bokhari S">S Bokhari</name></author><author><name sortKey="Perez Recio, T" uniqKey="Perez Recio T">T Perez-Recio</name></author><author><name sortKey="Zartoshti, A" uniqKey="Zartoshti A">A Zartoshti</name></author><author><name sortKey="Askanase, A" uniqKey="Askanase A">A Askanase</name></author><author><name sortKey="Geraldino Pardilla, L" uniqKey="Geraldino Pardilla L">L Geraldino-Pardilla</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gordon, C" uniqKey="Gordon C">C Gordon</name></author><author><name sortKey="Amissah Arthur, M" uniqKey="Amissah Arthur M">M Amissah-Arthur</name></author><author><name sortKey="Gayed, M" uniqKey="Gayed M">M Gayed</name></author><author><name sortKey="Brown, S" uniqKey="Brown S">S Brown</name></author><author><name sortKey="Bruce, I" uniqKey="Bruce I">I Bruce</name></author><author><name sortKey="D Ruz, D" uniqKey="D Ruz D">D D’Cruz</name></author></analytic></biblStruct></listBibl></div1></back></TEI></record>Pour manipuler ce document sous Unix (Dilib)
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