Hawkins Aaron M, Jesuthasan Lalith S B, Vardesh Deepak L
Department of Medicine, Logan Hospital, Meadowbrook, Queensland, Australia.
School of Medicine, Griffith University, Southport, Queensland, Australia.
BMJ Case Rep. 2018 Jun 19;2018:bcr-2018-225085. doi: 10.1136/bcr-2018-225085.
We report a case of severe lupus myocarditis with rapid, acute deterioration to cardiogenic shock and multiorgan failure, highlighting the importance of early identification and treatment of acute presentations in patients with systemic lupus erythematosus. A 31-year-old woman with previously diagnosed subacute cutaneous lupus erythematosus initially presented with abdominal pain and frank per-rectal bleeding. She deteriorated rapidly with type 1 respiratory failure and acute kidney injury requiring dialysis secondary to acute cardiac failure with a prolonged intensive care unit admission, over a month. A significantly elevated troponin, global hypokinesia on echocardiogram and normal coronary artery angiogram and cardiac MRI lead to the diagnosis of acute lupus myocarditis as the cause for the cardiogenic shock. She was treated with high-dose corticosteroids and eventually made a full recovery, with cardiac function returning to normal.
我们报告了一例严重狼疮性心肌炎患者，其迅速急性恶化为心源性休克和多器官功能衰竭，强调了系统性红斑狼疮患者急性表现的早期识别和治疗的重要性。一名先前诊断为亚急性皮肤型红斑狼疮的31岁女性最初表现为腹痛和明显的直肠出血。她迅速恶化，出现1型呼吸衰竭和急性肾损伤，因急性心力衰竭需要透析，在重症监护病房住院超过一个月。肌钙蛋白显著升高、超声心动图显示整体运动减弱以及冠状动脉造影和心脏磁共振成像正常，导致诊断为急性狼疮性心肌炎是心源性休克的原因。她接受了大剂量皮质类固醇治疗，最终完全康复，心脏功能恢复正常。
