Myocardial infarction secondary to premature coronary artery disease as the initial major manifestation of systemic lupus erythematosus.

A 32-year-old woman admitted to the emergency department was diagnosed with acute anterior myocardial infarction, treated with thrombolytics and referred for angiography on the basis of her age. The patient was then referred for angioplasty with the diagnosis of an atherosclerotic lesion in the left anterior descending (LAD) coronary artery. Successful treatment of the lesion by primary stenting ensued. Laboratory findings revealed a state of hypercoagulability as well as some collagen fibre disease. The final diagnosis, confirmed by a rheumatologist, was systemic lupus erythematosus (SLE) with premature atherosclerosis of the LAD in addition to hypercoagulability. A Medline search of the literature revealed limited previous reports of myocardial infarction due to premature coronary artery disease as the first manifestation in SLE.