Dilated Cardiomyopathy in patient with Systemic Lupus Erythematosus. Case report

INTRODUCTION: Systemic Lupus Erythematosus is an autoimmune disease of unknown etiology, whose clinical picture includes various cardiovascular manifestations, which occur in between the 50 and 60% of the patients. Myocarditis is a rare complication (10%) and may evolve to dilated cardiomyopathy, or to the improvement. CASE REPORT: Forty year old woman with a history of Systemic Lupus Erythematosus diagnosed in 2008 and previous hospitalization for nephrotic syndrome, consultates in the urgency of Guillermo Grant Benavente Hospital because of a two weeks clinical picture characterized by small effort dyspnea, oliguria and continuous edema of lower extremities. Stands in their entrance examinations: creatinine 1.8 mg / dl, CRP <5 mg/l, proteinuria /creatinine index >5; X-ray shows cardiomegaly. It is decided to hospitalized the patient. Evolves with increasing respiratory distress and chest pain, so it is decided to do echocardiogram, wich revealed dilated cardiomyopathy and severe systolic dysfunction. It′s added to her prevoiuos steroid treatment, furosemide, carvedilol, enalapril, methylprednisolone and cyclophosphamide. The patient has a satisfactory evolution, with decreased dyspnea and mild edema of the lower extremities, although it remains with altered values of creatinine. The patient is sent home and referred to early control. DISCUSSION: We propose that dilated cardiomyopathy is a rare complication of Systemic Lupus Erythematosus, and though we can say that it is the main explanation for the clinical picture of this patient, it does not explain by itself the symptomatology, considering the history of renal involvement.