Preprint Case Report Version 1 Preserved in Portico This version is not peer-reviewed

Perimyocarditis as First Manifestation of Systemic Lupus Erythematosus Successfully Treated With Heart Failure and Immunosuppressive Therapy

Version 1 : Received: 23 January 2023 / Approved: 25 January 2023 / Online: 25 January 2023 (09:45:32 CET)

A peer-reviewed article of this Preprint also exists.

Ikić Matijašević, M.; Grubić Rotkvić, P.; Planinić, Z.; Ikić, L.; Zadro Kordić, I.; Galić, E. Perimyocarditis as First Manifestation of Systemic Lupus Erythematosus Successfully Treated with Heart Failure and Immunosuppressive Therapy. J. Cardiovasc. Dev. Dis. 2023, 10, 134. Ikić Matijašević, M.; Grubić Rotkvić, P.; Planinić, Z.; Ikić, L.; Zadro Kordić, I.; Galić, E. Perimyocarditis as First Manifestation of Systemic Lupus Erythematosus Successfully Treated with Heart Failure and Immunosuppressive Therapy. J. Cardiovasc. Dev. Dis. 2023, 10, 134.

Abstract

Systemic lupus erythematosus (SLE) myocarditis is presumed to be rare but associated with ad-verse outcomes. If SLE diagnosis has not previously been established, its clinical presentation is often unspecific and difficult to recognize. Furthermore, there is a lack of data in the scientific literature regarding myocarditis and its treatment in systemic immune-mediated diseases, leading to its late recognition and undertreatment. We present the case of a young woman whose first lupus manifestations included acute perimyocarditis, among other symptoms and signs that provided clues to the diagnosis of SLE. Transthoracic and speckle tracking echocardiography were helpful in detecting early abnormalities in myocardial wall thickness and contractility while waiting for cardiac magnetic resonance (CMR). Since the patient presented with acute decompensated heart failure (HF), HF treatment was promptly started in parallel with immunosuppressive therapy, with a good response. In the treatment of myocarditis with heart failure, we were guided by the echocardiographic findings, biomarkers for myocardial injury N-terminal pro b-type natriuretic peptide (NT-proBNP) and hs-troponin I, biomarkers for systemic inflammation erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), and biomarkers for SLE disease activity (Complement C)3, C4, and anti-dsDNA levels.

Keywords

systemic lupus erythematosus; heart failure; myocarditis; pericarditis; speckle tracking echocardiography; transthoracic echocardiography; immunosuppressants; glucocorticoids; therapy; biomarkers

Subject

Medicine and Pharmacology, Cardiac and Cardiovascular Systems

Comments (1)

Comment 1
Received: 30 January 2023
Commenter: (Click to see Publons profile: )
The commenter has declared there is no conflict of interests.
Comment: Thank you for this interesting case report. My humble comments to improve this important article are:
1) The abbreviations: In the abstract: many experts and journals advise using them only for terms that occur more than twice. However, the important thing is that authors should introduce the abbreviation again when their full term appears the first time in the main body of the manuscript. (Usually the abstract is treated as a separate document from the article relating to it)
2) Case presentation:
a) Lacks important ordered clinical description: full vital sign report mentioning values even if normal. inspection, palpation auscultation findings should be reported beside more specific symptoms and signs such as cough, palpitation, LL edema, ascites, ..etc. It is also missing a thorough reporting of past history of disease and therapies, beside family and social history.
b) To avoid repetition authors may wish to omit reference ranges from in-text mention as they occur later in Table 1.
c) Suggest moving position of reference range column to be the last column (3rd) in the Table 1 (bring patient values first).
d) Reference to (Table 1) in the body should be located just after mentioning the lab values and before the mention of positive or negative ECG finding. Also in the last paragraph of case presentation may move it to just before the sentence and is continuously taking bisoprolol...HCQ.
e) The clinical manifestations of HF and its later improvement in this patient may need more details in description.
f) Time factors: There should be clear reporting of times and durations of occurrence of events, decisions, procedures, testing, consultations, introduction of therapy ..etc using explicit time units (e.g. on '3rd hospital day', 'five days later' ..) avoiding vague expressions such as soon', 'immediately', 'later' ..etc. Kindly remember to mention the duration of stay in, and discharge from the hospital. A timeline table or figure would highly enhance readability and elicit the importance of this interesting case report.
3) Discussion section': The whole length lies in 'one-block' of text . It may benefit from dividing into several shorter paragraphs according to context. This applies also to some parts in the other sections.
Thank you
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