Dengue-induced pancarditis manifestation of young female with systemic lupus erythematosus: case report

Lupus activity is associated with cardiac manifestation with varied clinical spectrum from asymptomatic disease-to-fulminant heart failure (HF) and cardiogenic shock. Pancardiac inflammation manifestation in systemic lupus erythematosus (SLE) patient with acute HF manifestation is relatively rare condition. Although, the most common cardiac involvement of SLE is pericarditis. However, cardiac involvement of SLE can affect all layers of the heart: endocardium as valvulitis, myocardium, and pericardium. Overt lupus myocarditis was a rare occurrence (5%–10%), but has a fatal outcome, and this was associated with worse prognostic. While, valvulitis manifestation of SLE is also rare compared to pericarditis, it accounts for less than 20% of SLE.

A 39-year-old female presented with acute HF symptom with vasculitis sign phenomena and renal insufficiency. Laboratory result showed leukocytopenia and thrombocytopenia. Echocardiography finding marked for valvulitis, myocarditis, and pericarditis involvement. Rheumatology work-up was significant for SLE with high disease activity. Other serology work-up showed positive dengue virus IgM. The patient was diagnosed with dengue-induced pancarditis with lupus nephritis. The patient was administered corticosteroid, HF medication, and cyclosporin. After 3 months follow-up, we found significant improvement in clinical and echocardiography functional parameter.

Systemic lupus erythematosus is a chronic systemic autoimmune disease, and the proposed mechanism of lupus flare in our case is related to dengue-triggered immunological activation. There are enormous reported cases of complete myocardial function recovery after several months of steroid therapy in SLE with cardiac manifestation. The improvement of functional imaging parameters reflected a favourable clinical response to immunosuppressive therapy.