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New Heart Murmur and Fever in a Patient With Systemic Lupus Erythematosus

New Heart Murmur and Fever in a Patient With Systemic Lupus Erythematosus Abstract A 30-year-old woman with a two-year history of systemic lupus erythematosus (SLE) treated with corticosteroids (prednisone, 17.5 mg/day) was initially seen with daily fevers, increased arthritis activity, and headache. Physical examination disclosed a temperature of 40 °C, a malar rash, a grade 2/6 apical systolic decrescendo murmur, and an asymmetrical synovitis. Laboratory data included the following values: hematocrit, 30%; WBCs, 1,700/cu mm; platelets, 95,000/cu mm; positive anti-DNA, 1:100; 24-hour creatinine clearance, 72 mL/min; and 24-hour urine protein reaction, 2.6 g. An ECG showed sinus tachycardia with nondiagnostic repolarization changes. She remained in a toxic condition despite increased corticosteroid therapy, with new extrapyramidal signs and an increase in intensity of the murmur to a grade 4/6. A superficial thrombophlebitis was noted at a former site of intravenous (IV) injection in her right arm. Cultures of blood, urine, and vaginal fluid were positive for β-hemolytic Streptococcus. The echocardiogram is shown in References 1. Gross L: The cardiac lesion in Libman-Sacks disease with a consideration of its relationship to acute diffuse lupus erythematosus. Am J Pathol 1940;16:375-419. 2. Shearn MA: The heart in systemic lupus erythematosus. Am Heart J 1959;58:452-466.Crossref 3. Brigden W, Bywaters EG, Lessof MH, et al: The heart in systemic lupus erythematosus. Br Heart J 1960;22:1-16.Crossref 4. Bulkley BH, Roberts WC: The heart in systemic lupus erythematosus and the changes induced in it by corticosteroid therapy: A study of 36 necropsy patients. Am J Med 1975;58:243-264.Crossref 5. Harvey AM, Schulman LE, Tumulty PA, et al: Systemic lupus erythematosus: A review of the literature and clinical analysis of 138 cases. Medicine 1954;33:291-437.Crossref 6. Fox IS, Spence AM, Wheelis RF, et al: Cerebral embolism in Libman-Sacks endocarditis. Neurology 1980;30:487-491.Crossref 7. Maniscalco BS, Felmer JM, McCans JL, et al: Echocardiographic abnormalities in systemic lupus erythematosus, abstracted. Circulation 1975;52( (suppl 2) ):211. 8. Elkayam U, Weiss S, Laniado S: Pericardial effusion and mitral valve involvement in systemic lupus erythematosus. Ann Rheum Dis 1977;36:349-353.Crossref 9. Ito M, Kagiyama R, Omura I, et al: Cardiovascular manifestations in systemic lupus erythmematosus. Jpn Circ J 1979;43:985-994.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

New Heart Murmur and Fever in a Patient With Systemic Lupus Erythematosus

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Publisher
American Medical Association
Copyright
Copyright © 1982 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1982.00340170183028
Publisher site
See Article on Publisher Site

Abstract

Abstract A 30-year-old woman with a two-year history of systemic lupus erythematosus (SLE) treated with corticosteroids (prednisone, 17.5 mg/day) was initially seen with daily fevers, increased arthritis activity, and headache. Physical examination disclosed a temperature of 40 °C, a malar rash, a grade 2/6 apical systolic decrescendo murmur, and an asymmetrical synovitis. Laboratory data included the following values: hematocrit, 30%; WBCs, 1,700/cu mm; platelets, 95,000/cu mm; positive anti-DNA, 1:100; 24-hour creatinine clearance, 72 mL/min; and 24-hour urine protein reaction, 2.6 g. An ECG showed sinus tachycardia with nondiagnostic repolarization changes. She remained in a toxic condition despite increased corticosteroid therapy, with new extrapyramidal signs and an increase in intensity of the murmur to a grade 4/6. A superficial thrombophlebitis was noted at a former site of intravenous (IV) injection in her right arm. Cultures of blood, urine, and vaginal fluid were positive for β-hemolytic Streptococcus. The echocardiogram is shown in References 1. Gross L: The cardiac lesion in Libman-Sacks disease with a consideration of its relationship to acute diffuse lupus erythematosus. Am J Pathol 1940;16:375-419. 2. Shearn MA: The heart in systemic lupus erythematosus. Am Heart J 1959;58:452-466.Crossref 3. Brigden W, Bywaters EG, Lessof MH, et al: The heart in systemic lupus erythematosus. Br Heart J 1960;22:1-16.Crossref 4. Bulkley BH, Roberts WC: The heart in systemic lupus erythematosus and the changes induced in it by corticosteroid therapy: A study of 36 necropsy patients. Am J Med 1975;58:243-264.Crossref 5. Harvey AM, Schulman LE, Tumulty PA, et al: Systemic lupus erythematosus: A review of the literature and clinical analysis of 138 cases. Medicine 1954;33:291-437.Crossref 6. Fox IS, Spence AM, Wheelis RF, et al: Cerebral embolism in Libman-Sacks endocarditis. Neurology 1980;30:487-491.Crossref 7. Maniscalco BS, Felmer JM, McCans JL, et al: Echocardiographic abnormalities in systemic lupus erythematosus, abstracted. Circulation 1975;52( (suppl 2) ):211. 8. Elkayam U, Weiss S, Laniado S: Pericardial effusion and mitral valve involvement in systemic lupus erythematosus. Ann Rheum Dis 1977;36:349-353.Crossref 9. Ito M, Kagiyama R, Omura I, et al: Cardiovascular manifestations in systemic lupus erythmematosus. Jpn Circ J 1979;43:985-994.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Apr 1, 1982

References