An unusual but reversible cause of ventricular fibrillation

A 61-year-old woman was admitted with general malaise, chest pain and breathlessness. During her inpatient stay she sustained a ventricular fibrillation (VF) arrest which was successfully terminated with direct current cardioversion. Cardiac investigations revealed poor left ventricular systolic function but unequivocally normal coronary arteries. During the course of her admission a macular rash developed and following investigations including a renal biopsy, a new diagnosis of systemic lupus erythematosus (SLE) and related myocarditis was reached. First presentation of lupus with myocarditis and VF is uncommon, however reaching the correct diagnosis is important as due to the reversible nature of the condition and improvement in left ventricular systolic function with medical therapy, an implantable cardioverter defibrillator (ICD) might not be appropriate. Our case report demonstrates the importance of screening for reversible conditions when considering ICD therapy for secondary prevention of malignant arrhythmias.