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An unusual presentation of systemic lupus erythematosus
R Uppal1, M N Sheppard, P Magee
1Department of Cardiothoracic Surgery, London Chest Hospital, UK.
Insights
Systemic lupus erythematosus (SLE) can present unusually. A young man
Area of Science:
- Cardiology
- Rheumatology
- Neurology
Background:
- Systemic lupus erythematosus (SLE) is a chronic autoimmune disease.
- Cardiac involvement in SLE can manifest in various ways, including myocardial infarction and thrombus formation.
- Neurological symptoms, such as hemiparesis, are recognized but less common initial presentations of SLE.
Abstract:
A case of right hemiparesis in a 22-year-old, caucasian male is presented. Echocardiography and an indirect left ventriculogram revealed a mass in the left ventricle which was eventually removed at surgery. Histology of the ventricular wall revealed thrombus superimposed on a full thickness myocardial infarction with florid intimal proliferation of small arteries. This histological picture suggested a diagnosis of systemic lupus erythematosus. Serum immunology revealed raised antibody titres in keeping with systemic lupus erythematosus. This is an unusual presentation where the only manifestation of disease was hemiparesis secondary to an embolic episode, from thrombus in the left ventricle subsequent to a small localised myocardial infarct.