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Unusual presentation of more common disease/injury
CASE REPORT
Case of severe acute lupus myocarditis and multiple-organ failure
  1. Aaron M Hawkins1,2,
  2. Lalith S B Jesuthasan3,
  3. Deepak L Vardesh1,2
  1. 1Department of Medicine, Logan Hospital, Meadowbrook, Queensland, Australia
  2. 2School of Medicine, Griffith University, Southport, Queensland, Australia
  3. 3Department of Cardiology, Logan Hospital, Meadowbrook, Queensland, Australia
  1. Correspondence to Dr Aaron M Hawkins, aaron_hawkins91{at}hotmail.com

Summary

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.

  • cardiovascular medicine
  • acute renal failure
  • rheumatology

https://doi.org/10.1136/bcr-2018-225085

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    Footnotes

    • Contributors AMH was the primary author; involved in the planning and conception process in collaboration with both other authors and involved in the acquisition of and collating the raw data and information, analysis, writing of the report and final editing and approval process. DLV made substantial contribution to the planning and conception of the project; collaborated extensively in the writing and editing process of the project and had final approval of the finished manuscript. LSBJ also made substantial contribution in the planning and conception of the project and assisted in writing and editing the report and had final approval of the finished manuscript. All the above authors are in agreement to be accountable for the article and to ensure that all questions regarding the accuracy or integrity of the article are investigated and resolved.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.