Shortness of breath in systemic lupus erythematosus: a diagnostic and therapeutic dilemma

• Published in: Annals of the rheumatic diseases Vol. 61; no. 7; pp. 588 - 590
• Main Authors: Goldblatt, F, Hill, W, Ahern, M J, Smith, M D
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and European League Against Rheumatism 01.07.2002; BMJ; BMJ Publishing Group Ltd; BMJ Publishing Group LTD
• Subjects: Adult; Atherosclerosis; Biological and medical sciences; Biopsy; breathlessness; Cardiomyopathy; Complications and side effects; Diagnosis; Drug dosages; Dyspnea - diagnostic imaging; Dyspnea - etiology; Female; Gangrene; Heart attacks; Heart failure; Heart Failure - etiology; high resolution computed tomography; HRCT; Humans; Hypertension; Inflammation; left ventricle; Lesson of the Month; Lupus; Lupus Erythematosus, Systemic - complications; Medical sciences; Myocarditis - diagnostic imaging; Myocarditis - etiology; Patients; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; SLE; Systemic lupus erythematosus; Tomography, X-Ray Computed - methods; Ulcers; Ultrasonic imaging; Urine; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - etiology; Australia; Human; Heart failure; Immunopathology; Connective tissue disease; Skin disease; Cardiovascular disease; Autoimmune disease; Case study; Symptomatology; Chemotherapy; Treatment; Heart disease; Systemic disease; Adult; Complication; Lupus erythematosus; Diagnosis; Disseminated
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/ard.61.7.588

Investigations showed urea 14.6 mmol/l (normal 3-8) and creatinine 0.145 mmol/l (normal 0.045-0.090), normal creatine kinase and troponin-t, albumin 18 g/l (normal 31-44), haemoglobin 98 g/l (normal 115-160), platelets 130x109/l (normal 150-450x109/l), white cell count 3.6x109/l (normal 4.0-11.0x109/l), C reactive protein 3 mg/l (normal 1-6), erythrocyte sedimentation rate 115 mm/1st h (normal 2-18), and 24 hour urine protein 4.2 g. She had a positive antinuclear antibody test (titre 1/2560) with extractable nuclear antigen specificity of anti-Ro/La/Sm/RNP autoantibodies, negative anticardiolipin antibodies, and dsDNA binding of 56 IU/ml (normal <7.0). DISCUSSION Cardiac involvement is a well recognised manifestation of SLE, and includes pericarditis reported in 50-74% of patients, endocardial involvement in 50-63%, premature atherosclerosis and primary myocardial involvement (myocarditis) in 8-81%, depending on series and diagnostic criteria. 1 Necropsy studies suggest that myocardial involvement is common, affecting up to 40% of cases, with areas of myocardial inflammation, necrosis, and fibrosis seen. 2 An endomyocardial biopsy is required for a confident diagnosis before death of myocarditis secondary to active SLE.