Mycophenolate Mofetil Use in Severe Myocarditis Complicating Systemic Lupus

Area of Science:

• Cardiology
• Rheumatology
• Immunology

Background:

• Cardiac involvement is a frequent complication of systemic lupus erythematosus (SLE).
• Myopericarditis, a severe form of cardiac lupus, can lead to life-threatening conditions like cardiogenic shock.
• Early recognition and etiological treatment are crucial for managing SLE-related cardiac complications.

Observation:

• A 33-year-old woman presented with acute heart failure, dilated cardiomyopathy, and reduced ejection fraction.
• Diagnostic workup revealed troponin-negative myopericarditis, acute renal impairment, and characteristic SLE markers (positive ANA, anti-dsDNA, anti-SM Abs).
• Clinical presentation included asthenia, arthralgia, cutaneous vasculitis, oral ulcers, and polyarthritis, strongly suggesting SLE.

Findings:

• The patient was diagnosed with lupus myopericarditis complicated by cardiogenic shock and acute kidney injury.
• Treatment with corticosteroids and mycophenolate mofetil resulted in significant improvement in left ventricular ejection fraction (from 20-25% to 45-50%) within 15 days.
• Successful management highlights the efficacy of immunosuppressive therapy in SLE-related myopericarditis.

Implications:

• This case underscores the importance of considering SLE in patients with unexplained myopericarditis, especially with extra-cardiac manifestations.
• Mycophenolate mofetil shows promise as an effective treatment for lupus myocarditis, a condition lacking standardized therapeutic guidelines.
• Aggressive immunosuppressive therapy alongside cardiac support can improve outcomes in severe cases of lupus myopericarditis.