Diagnosis and Treatment Delays Could Cost: Fatal Outcome of Lupus-Related Myopericarditis

We reported a case of severe lupus myopericarditis that rapidly progressed to cardiogenic shock. A 27-year-old woman with no significant medical history developed prolonged fever, weight loss, and acute dyspnea. Significantly elevated troponin levels, global hypokinesia, and a large epicardial effusion were found on echocardiography. The patient was initially diagnosed with systemic lupus erythematosus (SLE) according to the EULAR/ACR classification, fulfilling seven positive criteria. The diagnosis of acute lupus myopericarditis was highly suspected as the underlying cause of the cardiogenic shock. Furthermore, the patient did not undergo the CMR test due to restricted access and her instability. She was transferred to the critical care unit, initiated on noninvasive ventilation, and required dual inotropic support. Regrettably, the patient succumbed on the second day of hospitalization. Our case highlights the importance of early identification and treatment of acute presentations in patients with systemic lupus erythematosus.