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Systemic lupus erythematosus (SLE) is an autoimmune inflammatory disease of unknown origin that affects many organ systems. It is characterized by chronic inflammation that can induce abnormal vasomotion by reducing nitric oxide production and increasing endothelin-1 release, leading to endothelial injury and consequently to coronary artery spasm, which can progress to acute myocardial infarction (MI). This could be the result of either increased C-reactive protein, which induces significant expression of molecules associated with endothelial damage such as ICAM-1, VCAM1 and E-selectin, or expansion of CD4 CD28 T cells, which induce cytolysis in endothelial cells and/or activation of macrophages and other related interacting cells such as mast cells. Therefore an association with Kounis mast cell activation-associated syndrome, also known as coronary hypersensitivity disorder, cannot be excluded. In the very interesting paper by de Matos Soeiro et al. published in the Journal concerning 11 patients with acute coronary syndromes, it was concluded that coronary artery disease in young people with SLE due to premature atherosclerosis should be always be borne in mind because of its high mortality rate. Indeed, the following inflammatory substances and conditions that are associated with Kounis syndrome should be always considered in patients with lupus erythematosus, including:

Inflammation, systemic lupus erythematosus and the Kounis mast cell activation-associated syndrome