Sub-clinical systemic lupus erythematosus presenting with acute myocarditis

Area of Science:

• Immunology
• Cardiology
• Rheumatology

Background:

• Systemic lupus erythematosus (SLE) can present with diverse and severe manifestations.
• Myocardial involvement in SLE can be life-threatening and challenging to diagnose.
• Early recognition of SLE or lupus overlap is crucial for effective management.

Observation:

• A 46-year-old woman presented with fever and anemia, rapidly progressing to severe myocardial failure.
• The patient was unresponsive to inotropic support and broad-spectrum antibiotics.
• Classical SLE signs were absent, prompting investigation into an immunological cause.

Findings:

• Immuno-serology confirmed a diagnosis of SLE-like disease.
• High-dose steroid therapy resulted in a rapid clinical response.
• This case underscores the diagnostic challenge of SLE in atypical presentations.

Implications:

• Clinicians should consider SLE or lupus overlap in acutely ill patients with unexplained conditions.
• Prompt immuno-serological testing is vital for diagnosing SLE-like diseases.
• Early steroid treatment can be highly effective in managing severe SLE manifestations.