Ruptured aortic aneurysm in an adolescent with systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a chronic, multisystem, autoimmune disease. Cardiovascular involvement is frequent; however, aneurysm and/or aortic dissection are rare entities with fatal evolution. The objective is to describe a rare and fatal complication of SLE in pediatrics and review the literature. We present the case of a 16-year-old girl with SLE with multisystem involvement without cardiovascular disease at diagnosis. She consulted for severe chest pain. Chest X-ray showed a dilated aortic arch with no cardiomegaly. The presence of a dissection was suspected, and an angiotomography was performed. A descending aortic aneurysm without a dissection flap was confirmed. Antihypertensive treatment was started. After a Valsalva maneuver, she presented an aneurysmal rupture. She died 12 hours after admission. Aneurysm and dissection are infrequent complications in pediatric SLE. As they have high mortality, it is essential to consider them in a patient with SLE and chest pain.