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Systemic lupus erythematosus: calciphylaxis induced cardiomyopathy
Insights
Calciphylaxis, a rare condition, can mimic cardiovascular symptoms in patients with systemic lupus erythematosus (SLE). Differentiating calciphylaxis from SLE is crucial as treatments for SLE may worsen calciphylaxis.
Area of Science:
- Nephrology
- Cardiology
- Rheumatology
Background:
- Systemic lupus erythematosus (SLE) and chronic renal failure (CRF) can present with complex cardiovascular manifestations.
- Diabetes mellitus is a common comorbidity in patients with CRF and SLE.
Observation:
- A 31-year-old woman with SLE, diabetes, and CRF developed digital ischemia, myocardial dysfunction, ECG abnormalities, and elevated CPK.
- Vascular calcification was noted radiographically, but coronary angiography was normal.
- Endomyocardial biopsy revealed myocardial calcification without vasculitis or myocarditis.
Findings:
- The patient was diagnosed with calciphylaxis secondary to hyperparathyroidism.
- Calciphylaxis presented with cardiovascular symptoms typically associated with SLE.
Implications:
- Calciphylaxis can mimic cardiovascular SLE, necessitating careful differential diagnosis.
- Prompt differentiation is vital as SLE treatments may exacerbate calciphylaxis, highlighting the need for tailored management strategies.
Abstract:
A 31-year-old woman with systemic lupus erythematosus (SLE), diabetes mellitus, and chronic renal failure developed digital ischemia, myocardial dysfunction, abnormal ECG, and elevated CPK levels. Radiographic studies revealed calcification of the peripheral vasculature although coronary angiography was unremarkable. An endomyocardial biopsy demonstrated intra and extracellular myocardial calcification without evidence of vasculitis or primary myocarditis. A diagnosis of calciphylaxis, as a result of secondary hyperparathyroidism, was made. This case demonstrates that calciphylaxis can mimic the cardiovascular manifestations of SLE. Early differentiation of these disparate diseases is important because treatment strategies employed in SLE may exacerbate calciphylaxis.