Coronary artery bypass grafting in a patient initially presenting with systemic lupus erythematosus

Area of Science:

• Cardiology
• Rheumatology
• Critical Care Medicine

Background:

• Systemic lupus erythematosus (SLE) poses unique challenges in patients requiring cardiovascular surgery.
• Concomitant coronary artery disease (CAD) and SLE necessitates a multidisciplinary approach for optimal surgical outcomes.

Observation:

• A 51-year-old male with CAD and SLE underwent urgent coronary artery bypass grafting (CABG).
• Steroid therapy was initiated postoperatively due to SLE exacerbation, complicated by persistent infection and fever.
• Steroid dose reduction led to SLE worsening, requiring careful management of infection and renal function.

Findings:

• Gradual steroid dose regulation, balancing SLE control with infection risk, was crucial.
• Close monitoring of infection markers and renal function guided therapeutic adjustments.
• The patient stabilized and was discharged on postoperative day 60 without complications.

Implications:

• Acute SLE management requires meticulous perioperative strategies in patients undergoing open-heart surgery.
• Balancing immunosuppression and infection control is paramount in SLE patients with cardiovascular disease.
• This case underscores the need for individualized postoperative care plans in complex autoimmune and cardiac conditions.