Abstract
A 28-year-old woman was admitted to the hospital because of precordial pain. She had a well established diagnosis of systemic lupus erythematosus 9 years ago, manifested by butterfly erythema, polyarthralgia, proteinuria, leucopenia and thrombocytopenia. The patient was treated with 80mg prednisolone initially. She soon developed steroid-induced diabetes mellitus and prednisolone was tapered to 10mg/day. Her disease was clinically and serologically inactive for the last 5 years. However, hypertension, hypercholesterolemia, and mild diabetes mellitus persisted.
Electrocardiogram on admission revealed an antercseptal infarction. The S-GOT was 392 U per milliliter, the lactic dehydrogenase 2, 288 U per milliliter, the creatine phosphokinase 1, 843 U per milliliter, the total cholesterol 414mg per 100ml, the triglyceride 221mg per 100ml, and the creatinine 2.2mg per 100ml. The CRP was _??_, CH50 34.0 U per milliliter and immune complex was undetectable.
The coronary angiographic examination, performed on 52 nd hospital day, revealed 99% narrowing of the left anterior interventricular branch, and 50% and 75% stenoses of the posterior interventricular branch.
Although it was difficult to distinguish between atherosclerosis and arteritis by a coronary angiogram alone, together with clinical and serological findings, coronary atherosclercsis was considerd as the most probable cause of the myocardial infarction in this case.
