Ikić Matijašević Marina, Grubić Rotkvić Petra, Planinić Zrinka, Ikić Lucija, Zadro Kordić Ines, Galić Edvard
Internal Medicine Clinic, University Hospital Sveti Duh, 10 000 Zagreb, Croatia.
School of Medicine, University of Zagreb, 10 000 Zagreb, Croatia.
J Cardiovasc Dev Dis. 2023 Mar 23;10(4):134. doi: 10.3390/jcdd10040134.
Systemic lupus erythematosus (SLE) myocarditis is presumed to be rare, but associated with adverse outcomes. If SLE diagnosis has not previously been established, its clinical presentation is often unspecific and difficult to recognize. Furthermore, there is a lack of data in the scientific literature regarding myocarditis and its treatment in systemic immune-mediated diseases, leading to its late recognition and undertreatment. We present the case of a young woman whose first lupus manifestations included acute perimyocarditis, among other symptoms and signs that provided clues to the diagnosis of SLE. Transthoracic and speckle tracking echocardiography were helpful in detecting early abnormalities in the myocardial wall thickness and contractility while waiting for cardiac magnetic resonance. Since the patient presented with acute decompensated heart failure (HF), HF treatment was promptly started in parallel with immunosuppressive therapy, with a good response. In the treatment of myocarditis with heart failure, we were guided by the clinical signs, echocardiographic findings, biomarkers of myocardial stress, necrosis, and systemic inflammation, as well as markers of SLE disease activity.
系统性红斑狼疮（SLE）性心肌炎被认为较为罕见，但与不良预后相关。如果此前未确诊SLE，其临床表现通常缺乏特异性，难以识别。此外，科学文献中缺乏关于系统性免疫介导疾病中心肌炎及其治疗的数据，导致其诊断延迟和治疗不足。我们报告了一例年轻女性病例，其最初的狼疮表现包括急性心包心肌炎，还有其他一些症状和体征为SLE的诊断提供了线索。在等待心脏磁共振成像期间，经胸和斑点追踪超声心动图有助于检测心肌壁厚度和收缩力的早期异常。由于该患者出现急性失代偿性心力衰竭（HF），在进行免疫抑制治疗的同时迅速启动了HF治疗，且反应良好。在治疗伴有心力衰竭的心肌炎时，我们以临床体征、超声心动图检查结果、心肌应激、坏死和全身炎症的生物标志物以及SLE疾病活动标志物为指导。
