Myocardial Infarct in a Child With Systemic Lupus Erythematosus

Abstract

\s=b\An unusual case of systemic lupus erythematosus (SLE) in a young child is reported with sudden death from myocardial infarction.The diagnosis of lupus erythematosus in this patient was made by renal biopsy at the age of 3 years. Atherosclerosis of the coronary arteries and aorta was found at autopsy with occlusion of the anterior descending branch of the left coronary artery. It is suggested that the vascular changes in this case were related to hypertriglyceridemia and prolonged prednisone therapy superimposed on a hypersensitivity vasculitis related to SLE.(Am J Dis Child 132: [696][697][698][699] 1978) A 5-year-old girl had clinically diag-. nosed systemic lupus erythema¬ tosus (SLE). Even though electrocardiography did not suggest any abnor¬ mal findings, at autopsy coronary atherosclerosis and a recent thrombus in the anterior descending branch of the left coronary artery were asso¬ ciated with a myocardial infarcì in the anterior wall of the left ventricle and interventricular septum.This unusual case of SLE in a young child is reported because of the cardio¬ vascular involvement with sudden death from myocardial infarction.There are few reported cases of lupus erythematosus in children younger than 5 years of age; the majority of cases have involved chil¬ dren older than 10 years of age. WI 53706 (Dr Ishikawa). tosus in this patient was made by renal biopsy at the age of 3 years. Atherosclerosis of coronary arteriesand aorta in this case might be a consequence of hypertriglyceridemia and prolonged prednisone therapy superimposed on a hypersensitivity vasculitis related to SLE. REPORT OF A CASEThe patient was first seen at the Univer¬ sity of Wisconsin hospitals, Madison, at age 4V2 years with an acute onset of abdom¬ inal pain. She was first ill at age 9 months with purpura and idiopathic thrombocyto¬ penia, and subsequently her condition was diagnosed as lupus erythematosus on the basis of positive lupus erythematosus reac¬ tions and abnormal renal histology seen on a biopsy specimen. She was given azathio¬ prine and prednisone with apparent stabil¬ ization of renal function. At the time of the first admission, she was taking 7.5 mg of prednisone and 25 mg of azathioprine orally every day. Five days prior to admis¬ sion a temperature of 39.4°C developed that was associated with evanescent abdominal discomfort. There was no nau¬ sea or vomiting, but subsequently she became lethargic, anorectic, and she com¬ plained of diffuse abdominal pain. She had no abnormal stools. Her maternal aunt had SLE. Examination on admission showed a cushingoid appearance; blood pressure was 110/70 mm Hg; pulse rate, 120 beats per minute; respirations, 40 per minute; tem¬ perature, 39.4°C rectally. Heart and lung examinations were unremarkable. The abdomen was noticeably distended with hypoactive bowel sounds and a bilateral positive psoas sign. Diffuse rebound ten¬ derness was evident. Roentgenograms of the abdomen showed considerable gaseous distention in the stomach, but very little gas throughout the remaining bowel...

Noninflammatory Renal Microangiopathy of Systemic Lupus Erythematosus (‘Lupus Vasculitis’)

“…Of two types of lesions described, by far the more common vari ety involved arterioles and the smallest arteries and resembled those of malignant hypertension (MHT) even though most patients were not hypertensive. Similar microvascular lesions in SLE have been described in the gastrointestinal tract [3][4][5][6], heart [7], central nervous sys tem [8,9], skin [10,11] and placenta [12].…”

Lethal Manifestations of Systemic Lupus Erythematosus in a Forensic Context

“…Myocardial infarction is a common cause of unexpected death in the general population and is also an important cause in patients with SLE. However, myocardial infarction may occur at any age in SLE; for example, Ishikawa et al (28) reported a 5-year-old girl who died suddenly of an acute myocardial infarct resulting from coronary atherosclerosis with thrombus formation in the left coronary artery. Both long-term prednisolone therapy and vasculitis were considered contributing factors.…”

Dyslipoproteinemia in pediatric systemic lupus erythematosus

“…Premature atherosclerosis and its sequelae, myocardial infarction and cerebrovascular accident, have recently been recognized as complications of systemic lupus erythematosus (SLE) (1)(2)(3)(4)(5)(6)(7). Possible etiologies include dyslipoproteinemia, vasculitis, hypertension, and increased tendency for thrombosis associated with the presence of circulating anticoagulant (1)(2)(3)(4)(5)(6)(7)(8).…”

“…Possible etiologies include dyslipoproteinemia, vasculitis, hypertension, and increased tendency for thrombosis associated with the presence of circulating anticoagulant (1)(2)(3)(4)(5)(6)(7)(8).…”