Sudden Death in a 55-Year-Old Woman With Systemic Lupus Erythematosus

A 55-year-old woman with systemic lupus erythematosus (SLE) and hypertension was admitted for evaluation of a 1-week history of dyspnea and pleuritic chest pain. SLE was diagnosed 3 years ago and manifested as rash, recurrent angioedema, and arthritis. Maintenance therapy with continuous prednisone (10 to 50 mg/d) and briefly with methotrexate for 1 year controlled disease manifestations.Two months before admission, she developed increasing fatigue and malaise. One week before admission, a mild, nonproductive cough and chills were noted. Over the next several days, she developed progressively increasing dyspnea on exertion and bilateral, sharp, anterior chest pain that worsened with inspiration, supine position, and movement.The remainder of the past medical history was notable only for a miscarriage. Family history was unremarkable. The patient was a retired bookkeeper. She had smoked one-half pack of cigarettes per day for 20 years and had 1 alcoholic drink per day. There was no history of illicit drug abuse. Medications at the time of admission were prednisone 10 mg and sustained release nifedipine 60 mg daily. The patient was allergic to penicillin.On physical examination, the patient was in moderate respiratory distress. Blood pressure was 160 to 180 over 90 to 105 mm Hg, heart rate was 120 bpm, respiratory rate was 30 to 40 breaths per minute, and temperature was 99.1°F. The neck veins were flat. Lung sounds were decreased halfway up on the left and one third of the way up on the right. No evidence of consolidation was noted. A loud, 3-component pericardial friction rub was heard. No murmur or gallop was appreciated. A pulsus paradoxus was not present. No active synovitis or joint findings were noted. Pertinent laboratory findings on admission are noted in the Table⇓. The ECG on admission showed sinus tachycardia at 120 bpm.View this table: Table 1. Laboratory Values …