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Case Reports in Rheumatology
Volume 2018 (2018), Article ID 7635982, 4 pages
https://doi.org/10.1155/2018/7635982
Case Report

Hemorrhagic Tamponade as Initial Manifestation of Systemic Lupus with Subsequent Refractory and Progressive Lupus Myocarditis Resulting in Cardiomyopathy and Mitral Regurgitation

1Internal Medicine Department, Beaumont Hospital, Royal Oak, MI, USA
29 North Beaumont Hospital, Royal Oak, MI, USA
3Oakland University William Beaumont School of Medicine, Rochester, MI, USA
4General Internal Medicine Division, Beaumont Hospital, Royal Oak, MI, USA

Correspondence should be addressed to Alexandra Halalau

Received 30 September 2017; Revised 21 November 2017; Accepted 28 November 2017; Published 21 January 2018

Academic Editor: Jamal Mikdashi

Copyright © 2018 Nicole Marijanovich and Alexandra Halalau. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease with a wide range of clinical and serological manifestations. Cardiac disease among patients with SLE is common and can involve the pericardium, myocardium, valves, conduction system, and coronary arteries. We are reporting a case of SLE in a young woman that is unique is unique in that initial symptoms consisted of pericarditis and hemorrhagic tamponade which remained progressive and resistant to aggressive immunosuppressive treatment and led to severe cardiomyopathy (ejection fraction of 25%) and severe (+4) mitral regurgitation. Her immunosuppressive treatment included hydroxychloroquine, high-dose steroids, intravenous immunoglobulins, azathioprine, and mycophenolate mofetil. Her disease progression was felt to be due to underlying uncontrolled SLE because the complement levels remained persistently low throughout the entire course and PET Myocardial Perfusion and Viability study showed stable persistent active inflammation. Eventually, she was treated with cyclophosphamide which led to improvement in ejection fraction to 55% with only mild mitral regurgitation.