2019 Research Forum

Presenter: Leila Moosavi MD R3 Principal Investigator & Faculty Sponsor: Tiffany Win MD

An Unusual Case of SLE-Induced-Pericarditis in a Young Hispanic Male

Azadeh Ghassemi MS IV, Leila Moosavi MD R3, Fowrooz Joolhar MD, Tiffany Win MD

INTRODUCTION We present an unusual case of an otherwise young healthy Hispanic male with systemic lupus erythematosus (SLE) induced pericarditis. Autoimmune diseases especially SLE in general are more common in female. Pericarditis is one of the most commonly encountered cardiac complications in SLE, however, pericarditis as the first manifestation of SLE occurs very infrequently in otherwise healthy young Hispanic males. PURPOSE A 22-year-old Hispanic male presents to emergency department with a 48-hour history of progressive dyspnea and a constant sharp substernal chest pain that is exacerbated while lying flat. He also had a two-month history of bilateral wrist pain and swelling that had led to limited range of motion. On examination, this patient was febrile, tachycardic, tachypneic with normal oxygen saturation. A twelve- lead EKG revealed diffuse concave upward ST segment elevation with PR depression in leads I &II. Chest X-Ray demonstrated a left sided pleural effusion. Due to changes in EKG, an echocardiogram was ordered which revealed normal size left ventricle and an ejection fraction of 60% with normal appearing pericardium. His laboratory tests results were significant for leukocytosis without bands, elevated C-reactive protein, and erythrocyte sedimentation rate. Also, laboratory antibody tests for SLE revealed elevated smooth muscle antibody, SM/RNP antibody, and dsDNA antibody. IV fluid and broad-spectrum antibiotics were initiated for possible sepsis or septic joints prior to complete workup. Patient was admitted to our hospital and was diagnosed with SLE; he was discharged after his acute symptoms subsided. He has since followed up with both a cardiologist and a rheumatologist. An informed consent form was obtained from this patient. DISCUSSION Systemic lupus erythematosus (SLE) is an autoimmune disease of an unknown and multifactorial etiology. Immune complex deposition, complement activation and subsequent inflammatory reaction is responsible for many systemic manifestations of SLE. There is a higher prevalence among female in particular African-American and Hispanic women. Cardiovascular manifestations develop in the majority of SLE patients at some time during their illnesses, the most common being acute fibrinous pericarditis and pericardial effusion. Cardiovascular diseases, such as, thrombosis, hypertension and heart failure have become the leading causes of mortality and morbidity among SLE patients. Acute episode of SLE in a patient without prior diagnosis of SLE can mimic other life-threatening conditions such as sepsis. CONCLUSION Distinguishing between sepsis and acute episode of SLE especially in young otherwise healthy males can be extremely challenging. Therefore, clinicians should consider broader spectrum of differential diagnosis in order to minimize serious complication. The possibility of autoimmune diseases (i.e. SLE) should be included even in young otherwise healthy males presenting with a life-threatening systemic manifestations. Early diagnosis and prompt treatment will most likely result in an excellent outcome.

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