Katz Guy, Kolasinski Sharon L, Sundaram Baskaran, Loizidis Giorgos
Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Bulfinch 165, 55 Fruit St., Boston, MA 02114, USA.
Division of Rheumatology, University of Pennsylvania Perelman School of Medicine, Penn Musculoskeletal Center, 3737 Market Street, 8 Floor, Philadelphia, PA 19104, USA.
Case Rep Rheumatol. 2020 Oct 23;2020:8884759. doi: 10.1155/2020/8884759. eCollection 2020.
Patients with systemic lupus erythematosus (SLE) presenting with chest pain pose a unique diagnostic challenge, with causes ranging from cardiopulmonary disease to esophageal disorders and musculoskeletal chest wall pain. The most common biomarkers for myocardial injury are cardiac troponin T and I (cTnT and cTnI) due to their high sensitivity for the early detection of myocardial infarction. In the idiopathic inflammatory myopathies, cTnT is commonly elevated, and this reflects skeletal muscle breakdown rather than myocardial damage. Similar observations have not been reported in SLE myositis to date. We present two cases of patients with SLE and associated myositis who presented with chest pain and elevated cTnT. Both patients had a normal cTnI, transthoracic echocardiogram, and cardiac magnetic resonance imaging, likely indicating noncardiac chest pain. Clinicians should be aware that the specificity of cTnT might be lower in SLE myositis and that cTnI elevation may be more specific in detecting myocardial insult.
患有系统性红斑狼疮（SLE）并伴有胸痛的患者面临独特的诊断挑战，其病因范围从心肺疾病到食管疾病以及胸壁肌肉骨骼疼痛。由于心肌肌钙蛋白T和I（cTnT和cTnI）对心肌梗死的早期检测具有高敏感性，它们是最常见的心肌损伤生物标志物。在特发性炎性肌病中，cTnT通常会升高，这反映的是骨骼肌分解而非心肌损伤。迄今为止，SLE肌炎中尚未有类似的报道。我们报告了两例患有SLE及相关肌炎并伴有胸痛和cTnT升高的患者。两名患者的cTnI、经胸超声心动图和心脏磁共振成像均正常，这可能表明是非心脏性胸痛。临床医生应意识到，cTnT在SLE肌炎中的特异性可能较低，而cTnI升高在检测心肌损伤方面可能更具特异性。
