Al-Nokhatha Shamma Ahmad, Khogali Hiba Ibrahim, Al Shehhi Maryam Abdulla, Jassim Imad Tarik
Department of Rheumatology, Internal Medicine, Tawam Hospital, Al Ain, United Arab Emirates.
J Med Case Rep. 2019 Nov 20;13(1):343. doi: 10.1186/s13256-019-2242-1.
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.
心肌炎是系统性红斑狼疮的一种罕见表现，其临床表现范围从亚临床到危及生命。我们报告了两名患者的病例，他们以心肌炎作为系统性红斑狼疮的首发表现就诊于我院，尽管经过广泛检查排除了其他诊断，结果均为阴性。治疗的主要手段是使用皮质类固醇、免疫抑制剂和抗心力衰竭药物，后者的使用视具体情况而定。霉酚酸酯是诱导缓解的拟用治疗方案的基石，尽管众所周知它在狼疮性心肌炎中用作维持治疗。
两名阿联酋患者均符合混合性结缔组织病（以系统性红斑狼疮为主）和系统性红斑狼疮的诊断标准。心肌炎的其他鉴别诊断均被排除。患者开始接受脉冲类固醇治疗，随后口服类固醇，并根据需要使用羟氯喹、霉酚酸酯和抗心力衰竭药物。在最初几周内，症状方面出现了显著改善。
需要早期识别和治疗狼疮性心肌炎以避免致命后果。
