Tiny Bubbles: Coronary Aneurysms and Lupus

Among the cardiac complications that can be spurred by systemic lupus erythematosus, coronary aneurysms are a particularly challenging presentation. A 32-year-old woman with longstanding systemic lupus erythematosus was referred to us for treatment of New York Heart Association class III heart failure, including possible mitral valve replacement. She had diffuse proliferative lupus nephritis (class IV), chronic renal failure, hypertension, chronic anemia, and lung tuberculosis. She had no personal or family history of Kawasaki's disease, rheumatic heart disease, or coronary artery disease. Her drug regimen consisted of ramipril, bisoprolol, prednisone, isoniazid, rifampicin and pyrazinamide. She did not complain of recent chest, back, or upper limb pain. Here, Famularo et al discuss the assessment, diagnosis, and management of coronary aneurysms and lupus.