Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2020; 8(10): 2056-2065
Published online May 26, 2020. doi: 10.12998/wjcc.v8.i10.2056
Successful use of plasma exchange in fulminant lupus myocarditis coexisting with pneumonia: A case report
Zhou-Xiong Xing, Kun Yu, Hang Yang, Guo-Yue Liu, Ni Chen, Yong Wang, Miao Chen
Zhou-Xiong Xing, Kun Yu, Guo-Yue Liu, Ni Chen, Yong Wang, Miao Chen, Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
Hang Yang, Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
Author contributions: Xing ZX was the attending physician for the patient, reviewed the literature, and contributed to manuscript drafting; Yu K and Chen N performed the ultrasonography and interpretation and contributed to manuscript drafting; Yang H, Li GY and Wang Y summarized the clinical features and drafted the manuscript. Chen M reviewed the literature and was responsible for the important intellectual content of the manuscript; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Miao Chen, MD, Director, Professor, Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, No. 149 Dalian Road, Zunyi City 563000, Guizhou Province, China. chenmiao64@163.com
Received: January 30, 2020
Peer-review started: January 31, 2020
First decision: March 18, 2020
Revised: March 21, 2020
Accepted: April 18, 2020
Article in press: April 18, 2020
Published online: May 26, 2020
Abstract
BACKGROUND

Fulminant lupus myocarditis is a rare but fatal manifestation of systemic lupus erythematosus. Aggressive immunosuppressive treatments are important in its successful management. However, they can significantly damage the immunity and are associated with a considerable risk of infection development and spread. We present a rare and complicated case of a 20-year-old female diagnosed with fulminant lupus myocarditis accompanied by pneumonia. The patient was successfully treated with plasma exchange (PE) for fulminant lupus myocarditis.

CASE SUMMARY

A 20-year-old Chinese woman presented to the Hematology Department complaining of fatigue and knee pain. Blood test showed anemia and thrombocytopenia. On the second day of hospitalization, she was transferred to the ICU due to dyspnea and hypotension. Autoimmune profiles showed hypocomplementemia and positive antinuclear antibodies. Computer tomography showed an enlarged heart and pneumonia. Ultrasound revealed an enlarged heart with a low left ventricular ejection fraction. Fulminant lupus myocarditis with cardiogenic shock was initially considered. Due to the accompanying pneumonia, aggressive immunosuppression was contraindicated. Her cardiac function remained critical after the initial therapy of intravenous immunoglobulin and corticosteroids at a conventional dose, but she responded well to later PE therapy plus corticosteroids administration. The patient fully recovered with normal cardiac function.

CONCLUSION

This case indicates that PE is a valuable treatment choice without adverse effects of immunosuppression in patients with fulminant lupus myocarditis and coexisting infection.

Keywords: Plasma exchange, Cardiogenic shock, Lupus myocarditis, Systemic lupus erythematosus, Immunosuppressive treatment, Case report

Core tip: Fulminant lupus myocarditis with cardiogenic shock is rare but life-threatening. Although aggressive immunosuppressive treatment plays an important role in its successful management, it may lead to a considerable risk of infection development and spread. Plasma exchange (PE) can quickly remove antibodies and antigen-antibody complexes from lupus patients without adverse effects of immunosuppression and infection spread. Here, we present a rare and complicated case of a female patient successfully treated with PE for fulminant lupus myocarditis accompanied by pneumonia. This case indicates that PE is a valuable treatment choice without immunosuppression, especially for severe lupus myocarditis patients complicated by infection.