• Katya Meridor, Yehuda Shoenfeld, Oshrat Tayer-Shifman, and Yair Levy.
• Department of Internal Medicine E, Meir Medical Center, Kfar Saba.
• Medicine (Baltimore). 2021 May 7; 100 (18): e25591e25591.

IntroductionIntravenous immunoglobulin (IVIg) is currently used with considerable success for the treatment of many autoimmune diseases, including systemic lupus erythematosus (SLE). Among its various indications, IVIg has also been found to be beneficial in myocarditis, whether or not it is associated with an autoimmune disease. Nevertheless, data regarding IVIg treatment for myocarditis/cardiomyopathy in patients with SLE are sparse. The objective of this case series was to describe our experience with IVIg as a treatment for lupus myocarditis and to review the literature for IVIg for this indication.Patient ConcernsWe report 5 female patients with SLE, who presented with signs of acute heart failure including pulmonary congestion and arrhythmias.DiagnosisEchocardiography demonstrated new reduced left ventricular ejection fraction of 20% to 30%. Two patients underwent coronary artery angiography, which demonstrated normal coronary arteries, supporting the diagnosis of myocarditis or nonischemic cardiomyopathy.InterventionsHigh-dose IVIg treatment was initiated in all 5 patients.OutcomesFollowing the treatment, clinical and echocardiographic improvement in cardiac function occurred within a few days to 1 month. This dramatic improvement persisted for several years.ConclusionBased on our 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.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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