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SLE — SCE Rheumatology MCQ

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EasySLE & Antiphospholipid SyndromeSLESCE Rheumatology

A 30-year-old woman with systemic lupus erythematosus develops acute central chest pain that is worse on inspiration and when lying flat. She is tachycardic, and a pericardial friction rub is audible. ECG shows widespread concave ST-segment elevation with PR-segment depression. Troponin is normal. Echocardiography shows a small pericardial effusion, preserved left ventricular function and no regional wall-motion abnormality. What is the most likely diagnosis?

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Correct answer: E — Acute lupus pericarditis

The diagnosis is **acute lupus pericarditis**, an SLE-associated serositis. The decisive findings are positional pleuritic chest pain, a pericardial friction rub, widespread rather than territorial ST elevation with PR depression, and a small pericardial effusion. Pulmonary embolism may cause pleuritic pain and tachycardia but does not usually produce this ECG pattern. Myocardial infarction typically causes territorial ST elevation, reciprocal changes or regional wall-motion abnormality. Pneumothorax would be supported by unilateral respiratory findings and pleural air on imaging. Libman–Sacks endocarditis is a sterile valvular endocarditis and would be suggested by valvular vegetations or embolic phenomena. A normal troponin avoids implying associated myocardial injury; an elevated troponin with otherwise definite pericarditis would favour myopericarditis.

Reference: Peterson TA, Turner SP, Dolezal KA. Acute Pericarditis: Rapid Evidence Review. American Family Physician. 2024;109(5):441-446. https://pubmed.ncbi.nlm.nih.gov/38804758/