Cardiovascular Disease: Fellow Case Report Poster - Cardiovascular Disease |

A Rare Case of Lupus Myocarditis With Prolonged QTc Interval as Initial Presentation of SLE FREE TO VIEW

Prarthna Chandar, MBBS; Sakthidev Kulandaisamy, MD; Mangalore Amith Shenoy, MBBS; Yizhak Kupfer, MD; Chanaka Seneviratne, MD; Ishan Malhotra, MBBS; Pavan Irukulla, MBBS
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Maimonides Medical Center, Brooklyn, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):81A. doi:10.1016/j.chest.2016.08.089
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SESSION TITLE: Fellow Case Report Poster - Cardiovascular Disease

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Systemic lupus erythematosus (SLE) is an autoimmune disease with diffuse organ involvement.We report the rare occurrence of acute lupus myocarditis with prolonged QTc as the initial presentation.

CASE PRESENTATION: A 56 year old Asian woman with presented with non-specific complaints for 2 weeks.Work up showed pancytopenia with elevated liver enzymes and a positive rheumatologic work up for SLE.Symptoms improved with pulse steroid therapy and chloroquine.But with tapering of steroids,patient developed acute respiratory failure due to pulmonary edema requiring mechanical ventilation.Investigations at this time showed evidence of acute lupus myocarditis with severely reduced left ventricular function and prolonged corrected QT interval(>580ms).Patient was started on aggressive intravenous immunosuppressive therapy and there was gradual improvement of the myocardial function and decrease of the QT interval.Patient eventually was extubated and discharged with maintenance dose of steroids and chloroquine with rheumatology and cardiology follow up.Repeat echocardiography 2 months later showed normalization of the heart functions with return of ejection fraction back to normal limits.

DISCUSSION: SLE is an autoimmune disease with diffuse organ involvement.It primarily affects women under 50 years of age.. Subclinical liver disease is common.The incidence of lupus myocarditis (LM) ranges from 3 to 15%.Endomyocardial biopsy is necessary for definitive diagnosis.Early aggressive immunosuppressive therapy improves the cardiac outcome.Myocarditis and conduction defects occur more frequently in anti-Ro-positive than in anti-Ro-negative SLE patients and frequently display corrected QT prolongation associated with an increase in ventricular arrhythmias(1).Conduction abnormalities associated with SLE usually regress when the underlying disease is controlled.

CONCLUSIONS: Patients with SLE with respiratory failure should be evaluated for lupus myocarditis with evaluation of LV function with echocardiography and cardiac biomarkers. Aggressive immunosuppressive therapy can reverse lupus myocarditis and restore normal myocardial function. SLE patients that are positive for anti-Ro/SSA should be screened for QTc prolongation and cardiac conduction defects

Reference #1: Bourré-Tessier, J., Clarke, A. E., Huynh, T., Bernatsky, S., Joseph, L., Belisle, P. and Pineau, C. A. (2011), Prolonged corrected QT interval in anti-Ro/SSA-positive adults with systemic lupus erythematosus. Arthritis Care Res, 63: 1031-1037. doi: 10.1002/acr.20470

DISCLOSURE: The following authors have nothing to disclose: Prarthna Chandar, Sakthidev Kulandaisamy, Mangalore Amith Shenoy, Yizhak Kupfer, Chanaka Seneviratne, Ishan Malhotra, Pavan Irukulla

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