Systemic lupus erythematosus with myocarditis complicating pregnancy

Area of Science:

• Cardiology
• Rheumatology
• Maternal-Fetal Medicine

Background:

• Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect multiple organ systems.
• Pregnancy in women with SLE carries increased risks for both the mother and the fetus.
• Myocarditis, inflammation of the heart muscle, is a rare but serious cardiac complication.

Observation:

• A patient with SLE developed myocarditis during pregnancy, presenting with cardiomegaly and compensated congestive heart failure.
• Cardiac dysfunction persisted postpartum, creating a therapeutic dilemma for a subsequent pregnancy conceived six months later.
• Peripartum cardiomyopathy shares overlapping clinical features and prognosis with SLE-related cardiac involvement during pregnancy.

Findings:

• The persistent cardiac compromise post-pregnancy highlighted the significant maternal risk.
• The established poor maternal prognosis associated with peripartum cardiomyopathy informed the clinical decision-making.
• This case underscores the complex interplay between autoimmune disease, pregnancy, and cardiac health.

Implications:

• Careful risk-benefit assessment is crucial for pregnant patients with SLE and cardiac involvement.
• Early recognition and management of cardiac complications in pregnancy are vital.
• Termination of pregnancy may be considered when maternal prognosis is severely compromised by cardiac conditions.