Resolution of lupus-related left ventricular wall thickening and interstitial lung disease in a child with pulsed steroids and cyclophosphamide

Abstract

Cardiopulmonary involvement is one of the important manifestations of systemic lupus erythematosus (SLE) that tends to be more common in adults than children with SLE. SLE-related cardiopulmonary affection ranges from subclinical to life threatening condition. Although increased left ventricular mass and interstitial lung disease have been reported in association with SLE, the reversibility of such conditions with treatment of SLE was not sufficiently reported. Herein, we describe a female adolescent with SLE and lupus nephritis class III who presented as well with moderate dyspnea, tachycardia in absence of heart failure and hypertension. She had also productive cough of whitish sputum, no fever and both sputum and blood cultures were negative. Her echocardiography revealed left ventricular wall hypertrophy with preserved systolic function, electrocardiogram showed sinus tachycardia. Her pulmonary function tests revealed mild restrictive pattern and high resolution computed tomography revealed veiling of both lungs with increased attenuation and interstitial nodules with bilateral mild pleural effusion. She received full dose prednisone and intravenous monthly cyclophosphamide in addition to intravenous pulsed methylprednislone. She gradually improved with complete resolution of her cardiopulmonary disease and significant reduction of her proteinuria. In conclusion, cardiopulmonary involvement in relation to SLE could be reversible with adequate treatment leaving n