A contemporary case series of lupus myocarditis.
OBJECTIVE
The purpose of this study was to describe clinical phenotype and treatment outcomes in lupus myocarditis (LM), an uncommon but serious manifestation of systemic lupus erythematosus (SLE).


METHODS
The study involved a 10-year retrospective case series of hospitalized patients with LM, with a search of a diagnosis database using systemic lupus erythematosus and either myocarditis, cardiomyopathy, or congestive heart failure, and of a pathology database for biopsy-proved LM.


RESULTS
Twenty-four patients met the study criteria, with 79% female and 82% white (age: mean (SD), 47.6 (20.4) years; follow-up: mean (SD), 9.2 (6.1) months). The frequency of antibodies SS-A (69%) and anti-RNP (62%) was greater than in published lupus populations (25%-40%). On echocardiography, the mean initial left ventricular ejection fraction was 33.8%, improving to 49.5% after a mean of 7.2 months. All patients received immunosuppression, most with high-dose corticosteroid treatment and subsequent corticosteroid taper. One patient died of cardiogenic shock during hospitalization; two patients died within one year posthospitalization.


CONCLUSIONS
A high index of suspicion is necessary in suspected LM. Higher frequency of elevated SS-A and anti-RNP antibody levels in our series than in the literature is suggestive of an LM association. Echocardiography is a useful initial investigation for LM, but patients should be referred early for cardiac magnetic resonance imaging or endomyocardial biopsy to confirm diagnosis if it is clinically indicated in difficult cases.
Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
G M
GM
Zawadowski
K W
KW
Klarich
K G
KG
Moder
W D
WD
Edwards
L T
LT
Cooper
D000328:Adult; D000368:Aged; D000974:Antibodies, Antinuclear / Q000097:blood; D001706:Biopsy; D009202:Cardiomyopathies / Q000209:etiology; D017023:Coronary Angiography; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006760:Hospitalization; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000175:diagnosis / Q000276:immunology / Q000401:mortality / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D010641:Phenotype; D011237:Predictive Value of Tests; D020127:Recovery of Function; D012189:Retrospective Studies; D012261:Ribonucleoproteins / Q000276:immunology; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation; D016277:Ventricular Function, Left
D000974:Antibodies, Antinuclear; D007166:Immunosuppressive Agents; D012261:Ribonucleoproteins; C035356:SS-A antibodies