Unusual Ventilation-Perfusion Scintigraphy in Adult Respiratory Distress Syndrome Secondary to Acute Lupus Myocarditis

A 40-year-old Cambodian woman with newly diagnosed systemic lupus erythematosus developed acute biventricular failure and deteriorated rapidly despite high-dose immunosuppression. Due to persistent hypoxia and elevated pulmonary pressures on echocardiogram, a Tc-99m ventilation–perfusion scan was performed. The scan suggested a high probability of pulmonary emboli. Prior to the commencement of anticoagulation, the patient had a cardiac arrest and was unable to be resuscitated. Post mortem examination confirmed myocarditis. Lung tissue showed prominent, thickened alveolar membranes and inflammation of all lobes, consistent with adult respiratory distress syndrome. There was no evidence of pulmonary emboli or vasculitis affecting the lungs. The authors show an unusual cause for a high-probability lung scan.