Lethal manifestations of systemic lupus erythematosus in a forensic context

Area of Science:

• Rheumatology
• Pathology
• Cardiovascular Medicine

Background:

• Systemic lupus erythematosus (SLE) is a complex autoimmune disorder affecting multiple organs.
• While often chronic, SLE can present with sudden, unexpected fatalities.
• Cardiovascular complications are a significant concern in SLE patients.

Purpose of the Study:

• To review the diverse causes of sudden death in systemic lupus erythematosus.
• To highlight the role of cardiovascular disease and thrombosis in SLE-related mortality.
• To emphasize the importance of comprehensive autopsy in diagnosing fatalities.

Main Methods:

• Review of literature on sudden death in SLE.
• Analysis of common pathological findings in SLE fatalities.
• Discussion of diagnostic challenges in post-mortem evaluations.

Main Results:

• Accelerated atherosclerosis, antiphospholipid syndrome-associated thrombosis, and hypertensive cardiomegaly are frequent cardiovascular findings.
• Vasculitis and thrombosis can lead to critical organ infarction (e.g., heart, brain, intestines).
• Other causes include myocarditis, pulmonary hypertension, thromboembolism, sepsis, and epilepsy.

Conclusions:

• Sudden death in SLE is multifactorial, often involving cardiovascular and thrombotic events.
• Thorough autopsy with extensive histological and microbiological sampling is crucial for accurate determination of cause of death.
• Understanding these mechanisms aids in clinical management and prevention strategies for SLE patients.