Spontaneous dissection of coronary artery treated by primary stenting as the first presentation of systemic lupus erythematosus.

A 39-year-old woman was admitted to the Intensive Care Unit; she was diagnosed with acute anterior myocardial infarction, treated with thrombolytics, and referred for elective coronary angiography on the basis of her age. At angiography, the operator referred the patient for angioplasty with the diagnosis of a long atherosclerotic lesion in the left anterior descending coronary artery (LAD). On reviewing the angiogram, the interventionalist revised the initial diagnosis of an atherosclerotic lesion to a typical long spiral dissection of the LAD (spontaneous dissection). Successful treatment of the lesion by primary stenting ensued. Retrospective analysis of the laboratory findings revealed the presence of some collagen fiber disease. The final diagnosis, confirmed by renal biopsy, was systemic lupus erythematosus with secondary spontaneous dissection of the LAD.