Acute Myocardial Infarction in Young Systemic Lupus Erythematosus Patient with Normal Coronary Arteries

A 34-year-old female with a past medical history of systemic lupus erythematosus (SLE) and a deep venous thrombosis experienced substernal chest pain for 24 hours. Her physical exam was remarkable for brown macular rash over the face. Her initial electrocardiogram showed ST depression in lead V3–V6 along with an elevated troponin I level of 1.23 ng/dl (normal 0.0–0.4) that increased to 2.33 ng/dl in a four-hour duration. Cardiac catheterization revealed mild 10–20% focal plaque in the mid left anterior descending artery and otherwise normal coronary arteries. Laboratory data revealed an erythrocyte sedimentation rate of 98 mm/hour (normal 1–20), C-reactive protein of 25 mg/L (normal 0.0–2.9), and positive antinuclear antibody. In the absence of a significant coronary atherosclerosis along with elevated inflammatory markers, inflammation of coronary microcirculation was considered as an underlying pathophysiology of myocardial infarction. The patient was started on immunosuppression therapy with hydroxychloroquine and prednisone. Her chest pain improved and she was discharged in a stable condition. The patient remained stable and symptom-free over a follow-up period of nine months.