Systemic lupus erythematosus myocarditis after COVID-19 vaccination

IntroductionCases of acute myocarditis have been after administration of the BNT162b2 and Ad26.COV2.S vaccine.ObjectiveDescribe another possible mechanism of myocarditis after COVID-19 vaccination.Case presentationWe describe the clinical case of a 72-year-old female with pleuritic chest pain one week after the third of the BNT162b2 mRNA vaccine. Serological tests for cardiotropic pathogens were negative, and autoimmunity screening was positive with anti-nuclear antibody (ANA) in 1:160 dilution, Anti-double-stranded DNA (anti-dsDNA), and anti-histone antibodies. ¹⁸F-fluoro-deoxy-glucose (FDG) positron emission tomography/computed tomography (PET/CT) showed a focal myocardial and pericardial inflammatory process in the cardiac apex.Results and discussionSystemic lupus erythematosus (SLE) diagnosis was made with myocardial affection. As far as we know, this is the first report of a case of lupus myocarditis after the COVID-19 vaccine.ConclusionGiven the pathogenic rationales, the association between SLE and myocarditis should be considered.     

Systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is one of the most diverse autoimmune diseases as it may affect any organ in the body and display a broad spectrum of clinical and immunological manifestations. Epidemiological studies have identified marked differences in the prevalence and course of SLE between genders, and across different ages, races and geographic locations. Methodological differences between studies may account for some of the disparity seen. Additionally, some insights into possible environmental risk factors for SLE have also been provided. As this condition is relatively uncommon, multifactorial, and largely influenced by genetic predisposition, it is inherently difficult to confirm or exclude infectious or environmental contributors to its etiology. Movement of people between communities and defining specific exposures can also be problematic. Despite these limitations, ongoing observation of SLE cohorts in multiple countries and settings, along with large international cooperative efforts in recent years, have helped clarify the risks of SLE in various groups and have defined marked differences in the worldwide occurrence of the disease.     

Systemic lupus erythematosus

Systemic lupus erythematosus is an autoimmune connective-tissue disorder with a wide range of clinical features, which predominantly affects women, especially from certain ethnic groups. Diagnosis is based on clinical assessment supported by investigations, including the finding of autoantibodies. Treatments range from antimalarial agents to corticosteroids and immunosuppressive agents. This Seminar draws attention to advances in the epidemiology, genetics, cardiovascular risks, lupus nephritis, CNS disease, the antiphospholipid syndrome, assessment of disease activity and damage, and pregnancy related and quality of life issues. New therapeutic approaches, such as biological agents and mycophenolate mofetil, will also be discussed.     

Systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a typical autoimmune disease that leads to multiple organ damage. For over half a century, SLE has been treated mainly with nonspecific glucocorticoids and immunosuppressants, and the development of molecular target drugs with few adverse reactions is awaited. The treatment goal is remission without systemic symptoms or organ damage. An anti-B-cell activating factor antibody belimumab and an anti-type I interferon receptor antibody anifrolumab are used for patients with active SLE who respond poorly to standard of cares. Additionally, as many susceptibility genes for SLE are associated with signal transduction of dendritic and B cells, cytokines and signaling molecules that bridge the innate and adaptive immune systems are the current focus of attention. Promising approaches include the development of a Janus kinase inhibitors targeting tyrosine kinase deucravacitinib, plasmacytoid dendritic cell-targeted drugs, proteasome inhibitors (e.g., iberdomide), type II anti-CD20 antibody, and obinutuzumab.     

Systemic lupus erythematosus

Pregnancy occurring in patients with diagnosed and controlled SLE will be associated with a flare of disease in 60 per cent of cases, which is not significantly different from flares in nonpregnant patients. Signs and symptoms of active SLE should be carefully evaluated and treated with steroids according to severity and organ systems involved. When pregnancy occurs with inactive kidney disease there is a 10 per cent rate of reactivation and SLE kidney disease may appear for the first time during pregnancy in 6.8 per cent of patients. These rates are similar in the control group. There will be a significantly increased abortion rate which cannot be improved with maternal treatment. There will also be a high prematurity rate and an increased number of newborns with intrauterine malnutrition that are associated with active maternal disease. The following points are important when caring for a pregnant SLE patient: 1. Maintain maternal disease inactive throughout gestation. 2. Monitor growth and development of fetus. 3. Monitor for fetal distress. 4. Interrupt pregnancy when fetal distress is diagnosed. 5. A neonatal intensive care unit should be available at the time of delivery. The short-term prognosis is good with no maternal mortality and there is no long-term deleterious influence of pregnancy on the evolution of SLE.     

Systemic lupus erythematosus

This review covers major advances in clinical issues related to systemic lupus erythematosus (SLE) published between 1995 and 2000. The classification criteria for both SLE and antiphospholipid syndrome (APS) have been updated, and up to 19 different subsets of neuropsychiatric lupus have been defined. New epidemiological data show that the incidence of new cases and the survival of patients with SLE are both increasing. Several randomised controlled trials have defined the role of cyclophosphamide, methotrexate, antimalarials, and hormonal treatment in the management of SLE. New data are available for drugs such as ciclosporin and thalidomide. Finally, several new treatments for severe refractory cases, such as mycophenolate mofetil and stem-cell transplantation, are being increasingly used. New data also refer to management of thrombosis in APS and high-risk pregnancies in women with SLE or APS.     

Systemic lupus erythematosus

Systemic lupus erythematosus (SLE) in children and adolescents is a multisystem autoimmune disease with a great variability in disease presentation and course. The diagnosis of SLE is based on the clinical and laboratory features consistent with this illness in the absence of other autoimmune disease that could explain the findings. At the time of diagnosis of SLE, most, but not all, patients have at least four of the American College of Rheumatology classification criteria for SLE. This article summarizes available epidemiologic data, clinical patterns, approaches to investigation and treatment, and recent outcome data.