Journal List > J Korean Rheum Assoc > v.15(4) > 1003641

Lee, Jo, Kim, Kim, Lee, and Chung: A Case of Pneumomediastinum in the Course of Treatment in Lupus Myocarditis

Abstract

Systemic lupus erythematous (SLE) is systemic autoimmune disease of unknown etiology. SLE involve all part of heart but clinically important myocarditis is an unusual feature and is potentially fatal complication of SLE. We describe the woman who had diagnosed as SLE, 5 years ago and in that time, she had sinus tachycardia, mild dyspnea, chest discomfort, and depressed left ventricular function. She was diagnosed to myocarditis clinically and was treated by high-dose corticosteroids of intravenous pulse methylprednisolone. After treatment, she improved and showed improvement of left ventricular function. However, a sudden pneumomediastinum was occurred without trauma, and she died. The cause of pneumomediastinum was unexplained. We report a sudden pneumomediastinum in the course of lupus myocarditis presenting as sinus tachycardia with review of literature.

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Fig. 1.
A ECG shows sinus tachycardia and others are non specific finding.
jkra-15-322f1.tif
Fig. 2.
Transthoracic echocardiography (M-mode echocadiography) shows decreased ejection fraction (38%) (A). Follow-up transthoracic echocardiography shows improved ejection fraction (66%) than before (38%) (B).
jkra-15-322f2.tif
Fig. 3.
ECGs show that atrial fibrillation after 3 days of steroid pulse treatment, and there is no p waves (A), but normal sinus rhythm after 5 days of treatment, and p waves (arrows) are visible in lead (B).
jkra-15-322f3.tif
Fig. 4.
Chest PA shows extra-pleural air sign which means pneumomedastinum.
jkra-15-322f4.tif
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