Myocardial infarction as the presenting manifestation of systemic lupus erythematosus with antiphosphatidylserine antibodies.
BACKGROUND
The presence of antiphospholipid antibodies has been associated with thrombotic events in systemic lupus erythematosus and other diseases. Antiphosphatidylserine antibodies have been shown more recently to have clinical implications being noted in thrombocytopenia, positive VDRL test, prolonged partial thromboplastin time, and recurrent fetal loss.


OBJECTIVE
To report a patient with systemic lupus erythematosus who presented with a myocardial infarction resulting from a single clot in the distal left anterior descending coronary artery and to discuss the merits of evaluating such patients for the presence of antiphospholipid antibodies.


METHODS
Case report and review of the literature.


RESULTS
A 55-year-old woman with no risk factors for coronary artery disease presented with a myocardial infarction. A distal left anterior descending coronary artery clot was seen on angiography. Evaluation for the presence of a hypercoagulable state revealed evidence for systemic lupus erythematosus. Although lupus anti-coagulant and anticardiolipin antibody titers were negative, antiphosphatidylserine IgA antibodies were detected.


CONCLUSIONS
Because antiphosphatidylserine antibodies of the IgA isotype have been shown to be associated with thrombosis and other manifestations of systemic lupus erythematosus, a complete evaluation for antiphospholipid antibodies should include testing for all three isotypes.
Jansen
N L
NL
Department of Immunology/Microbiology, Rush Medical College, Chicago, Illinois, USA.
Snell
J R
JR
Moy
J N
JN
D017152:Antibodies, Antiphospholipid / Q000032:analysis*; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000276:immunology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology*; D010718:Phosphatidylserines / Q000276:immunology*
D017152:Antibodies, Antiphospholipid; D010718:Phosphatidylserines