A 28-year-old female with untreated systemic lupus erythematosus developed catastrophic multiorgan failure and cardiogenic shock (ejection fraction 20%), which improved with intensive immunosuppression.
Case Report (n=1)
This case highlights the potential for catastrophic multi-organ failure, including cardiac tamponade and cardiogenic shock, in untreated systemic lupus erythematosus, emphasizing the need for prompt multidisciplinary management.
Abstract Introduction Systemic lupus erythematosus is an autoimmune disorder with potential for fulminant and multisystem involvement. It is essential for patients to receive timely immunosuppressive therapy and rheumatologic management to prevent disease progression. However, treatment nonadherence and medical skepticism may lead to catastrophic disease flares. This young female presented with untreated SLE, developed concurrent cardiac tamponade, severe lupus nephritis, and cerebrovascular insult which resulted in multi-organ failure requiring intensive care management. Case Description A 28-year-old female with a history of systemic lupus erythematosus (SLE), diagnosed five years ago and noncompliant with medications, presented with six months of fatigue, urinary retention, and 30-pound weight gain. She was found to have a large pericardial effusion with tamponade physiology and cardiogenic shock, requiring emergent pericardial window. Despite intervention, she had persistent cardiogenic shock with an ejection fraction of 20%. Laboratory evaluation showed C3 of 38 mg/dL, C4 8 mg/dL, and anti-dsDNA 365 IU/mL. She developed acute kidney injury requiring hemodialysis; renal biopsy revealed class IV lupus nephritis and acute tubular necrosis. She was treated with pulse corticosteroids, cyclophosphamide, hydroxychloroquine, and plasmapheresis for an acute lupus flare. Her condition gradually improved, and she was extubated. On hospital day 8, she developed atrial fibrillation with rapid ventricular response and acute encephalopathy; MRI showed small right temporal lobe infarcts. She was discharged without any neurological defect and was on SLE therapy with close follow-up with neurology, nephrology, and rheumatology. Discussion This case highlights an exceptionally severe and rare presentation of SLE complicated by simultaneous myocarditis, pericardial effusion, peritonitis, and cardiogenic shock. A constellation of complications occurring during a single disease flare is unprecedented in the adult population, though each component is a recognized manifestation of active lupus. Myocarditis occurs in approximately 1-6% of adult SLE patients, depending on diagnostic criteria, while pericardial effusion affects up to 25% during their disease course. Peritonitis represents a significant organ manifestation in nearly 38% of patients, typically correlating with high disease activity. Cardiogenic shock secondary to lupus myocarditis or severe cardiac involvement remains exceedingly rare, with only isolated case reports available. This case underscores the importance of early recognition of cardiac and renal involvement during lupus flares, multidisciplinary management, and prompt initiation of immunosuppressive therapy to prevent irreversible organ damage. Furthermore, it highlights how poor treatment adherence can precipitate severe disease relapse with life-threatening multi-system complications. This abstract is funded by: None
Aversa et al. (Fri,) conducted a case report in Systemic lupus erythematosus (n=1). Pericardial window, pulse corticosteroids, cyclophosphamide, hydroxychloroquine, and plasmapheresis was evaluated. A 28-year-old female with untreated systemic lupus erythematosus developed catastrophic multiorgan failure and cardiogenic shock (ejection fraction 20%), which improved with intensive immunosuppression.