A case of multiple aneurysms with stenosis in the coronary and peripheral arteries of a patient with systemic lupus erythematosus

摘要

A 34-year-old woman was diagnosed with systemic lupus erythematosus (SLE) in 200X-19 and was treated with only prednisolone. In December 200X-1, she developed ulcers on the digits of her right hand for which anti-platelet agents were ineffective. Serology revealed high levels of anti-DNA antibodies and low levels of the complement factors C3 and C4. In May 200X, the patient was admitted to the hospital with pain in her finger. A physical examination revealed that her right brachial artery, but not her right radial artery, was palpable, leading to a suspicion of arterial obstruction. Electrocardiography performed upon admission revealed ischemic heart disease. Angiography of the upper extremities revealed blood flow obstructions in the right radial artery and bilateral ulnar arteries with multiple aneurysms, whereas imaging of the lower extremities also revealed bilateral obstruction of the anterior tibial and peroneal arteries. Coronary angiography revealed three-vessel disease with multiple aneurysms. Although coronary artery disease is common in patients with SLE, coronary artery aneurysms are rarely seen. Vasculitis, a potential cause of aneurysms in SLE patients, often progresses silently. In the present case, a pathological condition similar to peripheral vasculitis was thought to occur in the coronary arteries. This case provides valuable information regarding the occurrence of aneurysm in SLE.