Peculiarity of Systemic Lupus Erythematosus with Cardiac Involvement in Case Report and Literature Review
- Zeine El Abasse1
Systemic lupus erythematosus (SLE, or lupus) is a condition in which the immune system attacks healthy cells and tissues throughout the body, it is characterized by aberrant activity of the immune system, leading to variable clinical symptoms.
Case: A Moroccan 54 years old women presented a progressive dyspnea associated with palpitations with a history of hyperthyroidism, a pericardial effusion of great abundance punctured, the remainder of the diagnostic workup had revealed lupus erythematosus. The echocardiography found a global hypocontractility with an ejection fraction at 25%, moderate aortic regurgitation with an image of vegetation on the non-coronary cusp related to non-infectious endocarditis, andright ventricular dysfunction. Laboratory investigations revealed bycitopenia with high inflammatory markers, arenal dysfunction test result. Immunological tests showed a high positive antinuclear antibodies ans DNA antibodies. While hospitalization the patient presented an st segment elevation in the inferior derivation in relation with a coronary spasm and three days later a sudden hemiparesis with facial paralysis and aphasia, the emergency MRI objectified a cortical frontotemporal stroke, in the acute phase, the diagnosis of vasculitis of the central nervous system (CNS) was retained with ischemic and hemorrhagic lesions in favor of lupus vasculitis of the CNS.
Discussion: The case of our patient with Systemic lupus erythematosus involved: cardiac type of lupus myopericadtitis in biventricular dysfunction with LVEF: 25%,Normochromic normocytic anemia with positive coombs test and lymphopenia and thrombocytopenia ;lupus nephropathy satde IV ; Cerebral vasculitis. Cytopenias are common in patients with lupus, and moderate to severe lymphopenia is associated with high disease activity and organ damage.
The risk for ischemic stroke is higher in patient with SLE. The main cardiovascular diseases of SLE are valvular heart diseases associated with Libman-Sacks disease lesions; low ejection fraction is detected in the majority of the patients. Our patient had an ejection fraction around 25%. immunoglobulins (IVIGs) have been shown to improve cardiac function and mortality, in addition to the medical treatment of Heart failure.
Conclusion: Diagnosis of SLE can be challenging and while several classification criteria have been posed, their utility in the clinical setting is still a matter of debate. Despite several agents shown to be efficacious in the treatment of SLE, the disease still poses significant morbidity and mortality risk in patients.