Intravenous cyclophosphamide improves cardiac dysfunction in lupus myocarditis

We describe a Chinese woman who developed severe heart failure 3 years from the onset of systemic lupus erythematosus (SLE). Endomyocardial biopsy confirmed lupus myocarditis, with focal infiltrates of small lymphocytes and some polymorphic neutrophils. The conventional treatment for cardiac failure plus oral prednisolone failed to bring clinical and echocardiographical improvement until the addition of intravenous (i.v.) 'pulse' cyclophosphamide. Three weeks after i.v. cyclophosphamide treatment, there was significant improvement of her heart failure symptoms with improvement in the ejection fraction from 19% to 63%.