Cardiac Shock Revealing Systemic Lupus Erythematosus

ericarditis is the most commonly recognized cardiac complication in systemic lupus erythematosus (SLE).However, myocarditis with cardiac shock as the initial manifestation of SLE is uncommon.We describe a case of a 28-year-old man who presented cardiogenic shock revealing SLE. CASE REPORTA 28-year-old man, white, with a history of smoking, presented to the emergency department in December 2016 with dyspnea.Blood pressure was 165/75 mm Hg, pulse rate 113 beats per minute, body temperature 36°C, and oxygen saturation 100%.Cardiovascular examination was remarkable for signs of congestion with edemas of lower limbs.Skin examination revealed livedo on both feet (Figure 1).Initial laboratory data on admission showed the following: Troponin I 0.053 μg/L (N<0.034μg/L), brain natriuretic peptide 3342 pg/mL (N<100 pg/mL), aspartate transaminases 2334 IU/L (N<34 IU/L) and alanine transaminases 1120 IU/L (N<55 IU/L), white blood cell count 3700/mm 3 , hemoglobin 10.4 g/dL, platelet count 206 000/mm 3 , serum creatinine 84.9 μmol/L.Urine dipstick was negative for protein and blood.The ECG showed sinus tachycardia, negative T wave in V 4 through V 6 leads, and incomplete right bundle branch block.The chest radiograph revealed cardiomegaly.Echocardiography demonstrated a dilated cardiomyopathy and a biventricular edema, with a left ventricle ejection fraction evaluated at 15% to 20% without pericardial effusion and no significant valvulopathy.Two days later, physical examination showed a rapid decrease in blood pressure (85/70 mm Hg).Heart rate was 133 per minute and diuresis 500 mL/d.Blood lactate level was 3.5 mmol/L.These features were suggestive with a cardiogenic shock and dobutamine infusion was introduced.Contrast-enhanced cardiac magnetic resonance imaging showed multiple linear late intramyocardial contrasting of both ventricles suggestive of myocarditis (Figure 2).Coronary angiography was not performed.Serum