Abstract
Background A 24-year-old woman with an 11-year history of systemic lupus erythematosus presented with exacerbation of chronic abdominal pain followed by substernal chest pain. She had a history of pericarditis secondary to systemic lupus erythematosus and of varicella-zoster reactivation secondary to immunosuppression. Long-term medications included prednisolone, hydroxychloroquine, aspirin, and mycophenolate mofetil.
Investigations Physical examination, mesenteric angiography, CT of the abdomen, esophagogastroduodenoscopy, colonoscopy, pelvic ultrasound, laboratory testing, serologic testing, cardiac echocardiography, electrocardiography and coronary angiography.
Diagnosis Acute myocardial infarction secondary to severe multivessel atherosclerotic coronary artery disease.
Management Intra-aortic balloon pump followed by emergent four-vessel coronary artery bypass grafting. Aspirin, hydroxychloroquine, and mycophenolate mofetil were continued and a judicious tapering of prednisolone was initiated.
References
Nikpour M et al. (2005) Premature atherosclerosis in systemic lupus erythematosus. Rheum Dis Clin North Am 31: 329–354
Toloza SMA et al. (2004) Systemic lupus erythematosus in a multiethnic US cohort (LUMINA) XXIII. Baseline predictors of vascular events. Arthritis Rheum 50: 3947–3957
Fessler BJ et al. (2005) Systemic lupus erythematosus in three ethnic groups XVI. Association of hydroxychloroquine use with reduced risk of damage accrual. Arthritis Rheum 52: 1473–1480
Manzi S et al. (1997) Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with the Framingham Study. Am J Epidemiol 145: 408–415
Sella EM et al. (2003) Myocardial perfusion scintigraphy and coronary disease risk factors in systemic lupus erythematosus. Ann Rheum Dis 62: 1066–1070
Kwok Y et al. (1999) Meta-analysis of exercise testing to detect coronary artery disease in women. Am J Cardiol 83: 660–666
Jimenez S et al. (2005) Preclinical vascular disease in systemic lupus erythematosus and primary antiphospholipid syndrome. Rheumatology 44: 756–761
Asanuma Y et al. (2003) Premature coronary-artery atherosclerosis in systemic lupus erythematosus. N Engl J Med 349: 2407–2415
Birdas TJ et al. (2005) Outcomes of coronary artery bypass grafting in patients with connective tissue diseases. Ann Thorac Surg 79: 1610–1614
Wajed J et al. (2004) Prevention of cardiovascular disease in systemic lupus erythematosus—proposed guidelines for risk factor management. Rheumatology 43: 7–12
Wahl DG et al. (2000) Prophylactic antithrombotic therapy for patients with systemic lupus erythematosus with or without antiphospholipid antibodies: do the benefits outweigh the risks? A decision analysis. Arch Int Med 160: 2042–2048
Ridker PM et al. (2005) A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women. N Engl J Med 352: 1293–1304
Antithrombotic Trialists' Collaboration (2002) Collaborative meta-analysis of randomized trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 324: 71–86
Kang S et al. (2004) Effects of statin therapy on the progression of carotid atherosclerosis: a systematic review and meta-analysis. Atherosclerosis 177: 433–442
Jury EC and Ehrenstein MR (2005) Statins: immunomodulators for autoimmune rheumatic disease? Lupus 14: 192–196
Kiana A and Petri M (2004) Predictors of statin toxicity in the Lupus Atherosclerosis Prevention Study [abstract]. Arthritis Rheum 50 (Suppl): S406
Petri M et al. (1994) Effect of prednisone and hydroxychloroquine on coronary artery disease risk factors in systemic lupus erythematosus: a longitudinal data analysis. Am J Med 96: 254–259
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Written consent for publication was obtained from the patient reported in this Case Study.
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Galindo, M., Chung, L., Crockett, S. et al. Coronary artery disease in patients with systemic lupus erythematosus. Nat Rev Rheumatol 1, 55–59 (2005). https://doi.org/10.1038/ncprheum0037
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DOI: https://doi.org/10.1038/ncprheum0037
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