Sudden Cardiac Death in a Patient with Systemic Lupus Erythematosus and Cytomegalovirus Myocarditis

Main Article Content

Justin Chow
Umair Iftikhar
Victoria Weaver
Kwadwo Mponponsuo
Amy Bromley

Abstract

Background
Myocarditis is generally a self-limited illness with a benign course. Certain pathogens—such as cytomegalovirus (CMV)—can cause severe/fulminant forms of myocarditis leading to congestive heart failure or sudden cardiac death (SCD).


Case Presentation
A 54-year-old female was diagnosed with systemic lupus erythematosus (SLE) in hospital and received inpatient immunosuppression due to significant multi-organ involvement. After a prolonged admission, she later died of an in-hospital cardiac arrest. Autopsy revealed CMV myocarditis involving the anterior wall of the left ventricle and cardiac conduction system. We postulated that both CMV and complications of SLE caused the patient’s SCD.


Discussion
Myocarditis can vary in its presentation, severity, and diagnostic workup. Immunocompromised hosts are at risk of opportunistic infections such as CMV and are therefore prone to developing more severe forms of myocarditis. When caring for this patient population, it becomes necessary for clinicians to consider atypical manifestations of opportunistic pathogens in their diagnostic approach.


RESUME
Contexte
La myocardite est généralement une maladie autolimitée dont l’évolution est bénigne. Certains agents pathogènes, tels que le cytomégalovirus (CMV), peuvent provoquer des formes graves/ fulminantes de myocardite entraînant une insuffisance cardiaque congestive ou une mort cardiaque subite (MCS).


Présentation de cas
Une femme de 54 ans a reçu un diagnostic de lupus érythémateux disséminé (LED) à l’hôpital et a été hospitalisée pour une immunosuppression due à une importante atteinte de plusieurs organes. Après une longue hospitalisation, elle est décédée d’un arrêt cardiaque à l’hôpital. L’autopsie a révélé une myocardite à CMV impliquant la paroi antérieure du ventricule gauche et le système de conduction cardiaque. Nous avons émis l’hypothèse que le CMV et les complications du LED étaient tous deux à l’origine de l’arrêt cardiaque de la patiente.


Discussion
La myocardite peut varier dans sa présentation, sa gravité et son diagnostic. Les hôtes immunodéprimés sont exposés au risque d’infections opportunistes telles que le CMV et sont donc susceptibles de développer des formes plus graves de myocardite. Lorsqu’ils s’occupent de cette population de patients, les cliniciens doivent tenir compte des manifestations atypiques des agents pathogènes opportunistes dans leur approche diagnostique.

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