Heart Failure in Young Women with Systemic Lupus Erythematosus

We present two cases (females aged 23 and 36 years) with newly diagnosed systemic lupus erythematosus who developed lupus myocarditis concurrent with lupus nephritis. Both exhibited acute decompensated heart failure with dyspnea, edema, and cardiomegaly. Common key findings included strongly positive ANA blot, nephrotic-range proteinuria, acute kidney injury, and markedly elevated NT-proBNP (>35,000 pg/mL). Transthoracic echocardiography confirmed biventricular dysfunction (left ventricular ejection fraction [LVEF]: 20%-35% initially), moderate-to-severe tricuspid regurgitation, moderate-to-severe pulmonary arterial hypertension, and mild pericardial effusions. Both received high-dose pulse dexamethasone (40-60 mg IV), hydroxychloroquine (HCQ), diuretics, beta-blockers, SGLT2 inhibitors, and HCQ. The fulminant case additionally underwent plasma exchange. Both the patients, over the next few weeks, received cyclophosphamide therapy and achieved LVEF recovery to 50%-55% within 1-2 months, with improved renal function and resolution of heart failure symptoms. These cases underscore the reversibility of lupus myocarditis with early aggressive immunosuppression.