Sudden Cardiac Death in a Patient with Systemic Lupus Erythematosus and Cytomegalovirus Myocarditis

Background Myocarditis is generally a self-limited illness with a benign course. Certain pathogens—such as cytomegalovirus (CMV)—can cause severe/fulminant forms of myocarditis leading to congestive heart failure or sudden cardiac death (SCD). Case Presentation A 54-year-old female was diagnosed with systemic lupus erythematosus (SLE) in hospital and received inpatient immunosuppression due to significant multi-organ involvement. After a prolonged admission, she later died of an in-hospital cardiac arrest. Autopsy revealed CMV myocarditis involving the anterior wall of the left ventricle and cardiac conduction system. We postulated that both CMV and complications of SLE caused the patient’s SCD. Discussion Myocarditis can vary in its presentation, severity, and diagnostic workup. Immunocompromised hosts are at risk of opportunistic infections such as CMV and are therefore prone to developing more severe forms of myocarditis. When caring for this patient population, it becomes necessary for clinicians to consider atypical manifestations of opportunistic pathogens in their diagnostic approach.