Never say never: an asymptomatic man, cardiac lupus

Introduction: The cardiovascular mortality in patients with Systemic Lupus Erithematous is high and the tra-ditional CVD risk factors cannot be applied at these patients with the same sensibility as in the general po-pulation. Also, in the initial stages of disease, the cli-nical presentation of these patients is uncharacteristic, most of them being pauci- or asymptomatic. In these conditions, subtle changes in cardiac biomarkers valu-es, in ECG or echocardiography aspects may represent important tools for the diagnosis of subclinical organ damage.

Methods: A 31 years old man was transferred on inter-nal medicine clinic with the suspicion of LES under the conditions of laboratory coagulation disturbance – an increased INR and the value of a PTT over detection limit in association with positive VDRL and Trepo-nema pallidum haemagglutination (TPHA) test with uncertain result. The patient had three laboratory and one clinical SLICC criteria for LES (Direct Coombs test positive in the absence of haemolytic anemia, low com-plement, high levels of Anti-dsDNA and non-scarring alopecia respectively). An electrocardiogram showed a four seconds episode of atrial tachycardia with repola-rization abnormalities, sinus tachycardia otherwise and QRS fragmentation on inferior leads. In these condi-tions we decided cardiac investigations. The echocar-diography and ECG stress test were both normal, but the values of NT-proBNP and hs-troponinT were very high. The next step was cardiac MRI on which were detected subendocardial coronary lesion, especially in apical and lateral regions with an ejection fraction at the lower limit of normal.

Results: T he final diagnosis was LES with cutaneo-us and coronary involvement. We initiated treatment with systemic corticosteroids, hydroxychloroquine and aspirin. The patient’s evolution was favorable, with the normalization of cardiac biomarkers and a normal echocardiography at another two evaluations Conclusions: Systemic lupus erythematosus is a disea-se which occurs mostly in women, with a women/men ratio of 10:1. Our patient is a man to whom de diagno-sis of LES was suggested by laboratory findings, being clinical paucisymptomatic. In these conditions the de-cision of treatment would have been difficult to do. The

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)