Via Research Recognition Day 2024 VCOM-Carolinas

Clinical Case-Based Reports

Lupus Myopericarditis in a Young African American Male Chirag Lodha, OMS-III, Mohamed Abutineh, OMS-III, Nazar Sharak, D.O. Cleveland Clinic Indian River Hospital, Vero Beach, FL

Introduction

Results

Conclusions

• Myopericarditis is a rare complication of SLE. • Due to the overlap of myopericarditis and an acute coronary syndrome (ACS), they can be difficult to differentiate. • Patients with SLE suffer from an accelerated rate of atherosclerotic disease due to the inflammatory nature of autoimmune diseases. • African American males represent the demographic with the lowest prevalence of SLE. • High clinical suspicion of an ACS must be present, as coronary disease is the leading cause of mortality of SLE patients. • Suspicion of an ACS should increase as patients with autoimmune conditions grow older. • These patients also make up the majority of recurrent pericarditis cases. • The first line treatment of myopericarditis in patients with autoimmune disorders is glucocorticoids, even in the case of recurrent pericarditis.

• Systemic Lupus Erythematosus (SLE) is an autoimmune condition characterized by the wide variety of organ dysfunction it can cause. • Although African American females are the most affected demographic, African American males account for only 0.7% of SLE cases. • Males with SLE tend to have more serious organ dysfunction than females with SLE. • Disease onset begins nonspecifically, with fever, fatigue, malaise. • The leading cause of death of patients with SLE is coronary disease. • 28-year-old African American Male presents to the Emergency Department (ED) with chest pain. • States it has been ongoing for the past 3 days and describes it as localized to the center of his chest. • He notes that he cannot sleep on his side or on his stomach as this made his chest pain worse. • Notes some pain in both of his lower legs on his shins. • His past medical history was relevant for SLE diagnosed two months before this ED visit. • His labs were unremarkable besides a significantly elevated CRP, high-sensitivity troponin, and creatinine kinase. • On physical examination he was found to have bone pain well localized to the anterior tibias bilaterally. • On cardiac auscultation, he was found to have a scratching murmur along the left sternal border. • Due to his cardiac murmur and elevated troponin, he was diagnosed with myopericarditis secondary to a SLE exacerbation and treated with low-dose prednisone. • He improved quickly and was discharged 4 days later to his home with a regimen of prednisone and colchicine. Report of Case

Table 1. Patient ECG

Table 2. Patient labs

References

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2024 Research Recognition Day