第3子出産後に心筋炎で発症したSLEの1例

Abstract

A 36-year-old female developed systemic lupus erythematosus (SLE) complicated by myocarditis after delivery of her third child. Exertional dyspnea appeared within 2 months after her third delivery. On admission, a chest x-ray showed pulmonary congestion, bilateral pleural effusion, and enlargement of the cardiac silhouette. Urinalysis revealed proteinuria (1.2 g/day) and gross hematuria. Laboratory examinations disclosed leukocytopenia (2,500/μl), hypoalbuminemia (2.3 g/dl), renal dysfunction (serum creatinine, 1.7 mg/dl), hypocomplementemia (CH 50, 3U/ml), and the presence of anti- double-strand DNA antibodies. Endomyocardial biopsy revealed swelling of myocardial cells, infiltration of small mononuclear cells to the interstitium, and severe interstitial edema. SLE with myocarditis was diagnosed and the patient was treated with oral predonisolone at a starting dose of 60 mg/day. The treatment was markedly effective for this case. It is reported that myocarditis is present in about 50% of autopsy cases of SLE, with a frequency of 1% or below. This is a rare case of SLE presenting myocarditis at the onset after the third delivery.