Acute myocarditis as an initial manifestation of systemic lupus erythematosus: a case report

A rare case of systemic lupus erythematosus with initial manifestation of myocarditis is reported here, found in a 24-year-old female who presented first with an episode of exertional dyspnea, later developing life-threatening arrhythmia, and left ventricular dysfunction. There were no classical clinical manifestations of SLE such as arthragia or malar rashes as initial symptoms. Subsequently, the only clue was traced with positive ANA screening test. Central nervous system manifestations were found and proteinuria was detected. We ordered intravenous "pulses" of methylprednisolone, followed by maintenance of daily glucocorticoid because the criteria of SLE seemed applicable. The patient responded well and rapidly. This initial manifestation for SLE is so rare and unusual that it has not previously been described.