Coronary artery disease in young patients with systemic lupus erythematosus: two case reports.

The cardiovascular system is often involved during systemic lupus erythematosus (SLE), but only few studies have documented myocardial ischemia and myocardial infarction in young patients. We observed 2 cases of coronary artery disease in young patients with SLE and different clinical presentations. In the first case, a 26-year-old woman, with SLE diagnosed at the age of 12 years, was evaluated for angina (CCS class II). Myocardial scintigraphy revealed a clear reversible thallium-201 apical perfusion defect. During the following 5 years worsening effort angina led to coronary angiography which revealed the presence of a complete obstruction of the left anterior descending coronary artery (LAD) treated with surgical myocardial revascularization (internal mammary artery implantation on the LAD). The second patient had myopericarditis and an acute myocardial infarction 1 year before coming to our observation. Coronary angiography revealed the presence of 100% obstruction of the LAD. On this basis, a diagnosis of SLE was made. Our data constitute two relevant examples of coronary artery disease with different clinical presentation in young SLE patients.