In our case series, the response to high dose IVIg therapy was fast

In our case series, the response to high dose IVIg therapy was fast. case series, we believe that IVIg has an important role in the management of lupus acute cardiomyopathy. This safe, well-tolerated optional treatment should be considered, especially in severe cases. Keywords: acute cardiomyopathy, intravenous immunoglobulins, myocarditis, systemic lupus erythematosus 1.?Introduction Among the various treatment options for autoimmune diseases, IVIg is considered the mainstay of treatment for several conditions, especially Kawasaki disease and immune thrombocytopenic purpura. It is also used in the treatment of idiopathic inflammatory myopathies, antineutrophil cytoplasmic antibody vasculitis and autoimmune neurological conditions.[1C3] In the last 2 decades, our group as well as others demonstrated the beneficial effect of IVIg treatment for SLE,[4C11] with most data supporting amelioration of severe refractory flares and hematological manifestations following this therapy.[9C15] Some report that IVIg is also effective in lupus nephritis,[16,17] in neuropsychiatric manifestations,[18C20] and during pregnancy.[21] Cardiac involvement presents in up to 50% of SLE patients and pericarditis is the most frequent manifestation of SLE-related cardiac disease.[22] However, all other cardiac components may be involved: endocardium, myocardium, conduction tissue, and coronary arteries.[23] Lupus myocarditis (LM) is a rare but potentially fatal complication, affecting up to 10% of SLE patients.[22,24C26] It may present as an acute illness or have a chronic HD3 course with the development of cardiomyopathy.[26] The treatment of LM is generally empirical. Either oral or intravenous pulses of corticosteroids have been the mainstay of treatment, while cyclophosphamide, azathioprine, mycophenolate mofetil, and IVIg have also been used with some success.[26,27] High-dose IVIg in SLE is mainly used as an adjunctive therapy when the standard treatments are ineffective or when immunosuppressive regimen is contraindicated. However, data concerning IVIg treatment for myocarditis/cardiomyopathy in lupus are sparse. In this communication, we retrospectively review 5 cases who developed severe myocardial dysfunction, probably as a consequence of myocarditis secondary to SLE. PI-3065 All experienced dramatic improvement following IVIg therapy. 2.?Cases 2.1. Patient 1 The details of this case of a 59-year-old female patient were described elsewhere.[28] The patient presented to the Emergency Department (ED) with rectal bleeding. She had been diagnosed a few years earlier as having SLE, presenting with 4 of 11 American College of Rheumatology (ACR) criteria,[29] including arthritis, pleuritis, high antinuclear antibodies (ANA) titers (1:1280), and elevated anti-dsDNA antibody titers. She was successfully treated with a few courses of IVIg and steroids for secondary myelofibrosis.[15] Two months before admission, the patient had begun to receive 40?mg prednisone daily, which was continued throughout her admission. Upon admission, the patient was tachycardic, her blood pressure was 90/40?mm Hg, hemoglobin was 3.0?g/dL, white blood cell (WBC) count was 15.9??109/L and platelet count was 587??109/L. Both prothrombin time and partial thromboplastin time were within normal ranges and an electrocardiogram was unremarkable. Gastric suction exhibited coffee ground appearance of the gastric contents. Angiography of the mesenteric vessels exhibited a bleeding gastroduodenal artery. Consequently, embolization of the bleeding vessel, in addition to transfusion of 4 models of packed red blood cells were instrumental in stabilizing the patient’s condition and PI-3065 achieving a hemoglobin of 9.6?g/dL. Two days later, she developed PI-3065 a slow ventricular PI-3065 tachycardia and subsequently a ventricular fibrillation. After a successful resuscitation, she was transferred to the intensive care unit (ICU), where ST segment elevations were found in leads.