Dengue-Induced Pancarditis Manifestation of Young Female with Systemic Lupus Erythromatosus: Case Report

Background Lupus activity is associated with cardiac manifestation with varied clinical spectrum from asymptomatic disease-to-fulminant HF and cardiogenic shock. Pancardiac inflammation manifestation in systemic lupus erythromatosus (SLE) patient with acute HF manifestation is relatively rare condition. Although, the most common cardiac involvement of SLE is pericarditis but cardiac involvement of SLE can affect all layers of heart: endocardium as valvulitis, myocardium and pericardium. Overt lupus myocarditis (LM) was a rare occurrence (5-10 %), but has a fatal outcome and this was associated with worse prognostic. While, valvulitis manifestation of SLE is also rare compared to pericarditis. It is account to less than 20 % of SLE. Case Summary A 39-years old female presented with acute heart failure symptom with vasculitis sign phenomena and renal insufficiency. Laboratory result showed leukocytopenia and thrombocytopenia. Echocardiography finding marked for valvulitis, myocarditis and pericarditis involvement. Rheumatology work-up was signify for systemic lupus erythromatosus with high disease activity. Other serology work-up showed positive dengue virus IgM. The patient was diagnoses as dengue-induced pancarditis with lupus nephritis. The patient was administered corticosteroid, heart failure medication, and cyclosporin. After 3 months follow-up, we found significant improvement in clinical and echocardiography functional parameter. Discussion SLE is a chronic systemic autoimmune disease and the proposes mechanism of lupus flare in our case is related to dengue-triggered immunological activation. There enormous reported cases of complete myocardial function recovery after several months of steroid therapy in SLE with cardiac manifestation. The improvement of functional imaging parameters reflected favourable clinical response to immunosuppressive therapy.