Successful use of plasma exchange in fulminant lupus myocarditis coexisting with pneumonia: A case report  

作　　者：Zhou-Xiong Xing Kun Yu Hang Yang Guo-Yue Liu Ni Chen Yong Wang Miao Chen 

机构地区：[1]Department of Critical Care Medicine,Affiliated Hospital of Zunyi Medical University,Zunyi 563000,Guizhou Province,China [2]Department of Anesthesiology,Affiliated Hospital of Zunyi Medical University,Zunyi 563000,Guizhou Province,China

出　　处：《World Journal of Clinical Cases》2020年第10期2056-2065,共10页世界临床病例杂志

摘　　要：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.

关 键 词：Plasma exchange Cardiogenic shock Lupus myocarditis Systemic lupus erythematosus Immunosuppressive treatment Case report 

分 类 号：R593.241[医药卫生—内科学] R542.21[医药卫生—临床医学]