Intravenous cyclophosphamide improves cardiac dysfunction in lupus myocarditis.

Area of Science:

• Cardiology
• Rheumatology
• Immunology

Background:

• Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect multiple organs, including the heart.
• Lupus myocarditis, inflammation of the heart muscle due to SLE, can lead to severe heart failure.
• Conventional treatments for heart failure and SLE may not always be sufficient for managing lupus myocarditis.

Observation:

• A Chinese woman with a 3-year history of SLE developed severe heart failure.
• Endomyocardial biopsy confirmed lupus myocarditis, showing focal infiltrates of lymphocytes and neutrophils.
• Standard treatment for cardiac failure combined with oral prednisolone did not improve her condition.

Findings:

• The addition of intravenous (i.v.) 'pulse' cyclophosphamide to her treatment regimen led to significant clinical improvement.
• Echocardiographical assessment showed a marked increase in ejection fraction, from 19% to 63%, within three weeks of i.v. cyclophosphamide therapy.
• This case highlights the potential efficacy of cyclophosphamide in managing severe lupus myocarditis.

Implications:

• Intravenous pulse cyclophosphamide may be a valuable therapeutic option for severe lupus myocarditis unresponsive to conventional treatments.
• Early consideration of immunosuppressive therapy, such as cyclophosphamide, could improve outcomes in patients with SLE-related cardiac dysfunction.
• This case underscores the importance of considering specific autoimmune etiologies in refractory heart failure.