Coronary occlusion after recurrent myocardial perfusion abnormalities in a young SLE patient

Only a few studies have documented coronary artery disease and myocardial infarction in young patients with systemic lupus erythematosus (SLE). We observed a case of a young 26 years old SLE woman, with clear angina pectoris on mild effort. ECG showed Q waves in V3-V4, while no abnormalities had been shown in all previous ECGs. Doppler-echocardiography revealed a slight proximal antero-septal hypokinesia. Exercise Thallium-201 (T1-201) scintigraphy showed the presence of a clear septal reversible perfusion defect. A diagnosis of coronary artery disease was made, but the patient refused to undergo coronarography. She was subsequently treated with steroids and immunosuppressant agents, with resolution of the angina pectoris and disappearance of the T1-201 myocardial perfusion defect. During the following 2 years, the patient presented recurrent episodes of angina pectoris with a worsening in the latter period; new T1-201 myocardial imaging showed a progressively clearer image of myocardial apical perfusion defect. Finally, the patient accepted to undergo a coronarography, which showed the presence of a complete obstruction of the left anterior descending coronary artery, with good development of collaterals which provided a perfusion of the ischemic myocardium. She underwent a coronary artery by-pass grafting and is now healthy. It is likely that a rapid increase of anti-cardiolipin antibodies, and/or an enhancement of immunocomplex or chronic steroid treatment could lead to a slow development of an early coronary artery disease.