[Hypertensive emergency as the first manifestation of systemic lupus erythematosus].
METHODS
A 22-year-old female without relevant underlying medical conditions presented with an acute onset of dysphasia. Her blood pressure was found to be 190/90 mm Hg.


METHODS
Physical examination revealed left-sided hemiplegia and Broca's aphasia. A blood count showed anemia and thrombocytopenia. Cranial CT and MR imaging revealed small hypodense periventricular and cerebellar lesions. Mitral valve insufficiency and bilateral pleural effusion were found in echocardiography and chest x-ray, respectively.


METHODS
A hypertensive emergency with cerebral and cardiac end-organ lesions was diagnosed. Blood pressure could not be controlled despite combination therapy of intravenous antihypertensive drugs. A full check-up for secondary hypertension revealed systemic lupus erythematosus (SLE) and catastrophic antiphospholipid syndrome (APS). Treatment of SLE/APS resulted in considerable improvement of blood pressure.


CONCLUSIONS
After ruling out frequent causes of hypertensive emergencies, such as insufficient adherence to drug therapy of primary hypertension, or secondary hypertension caused by renoparenchymal disease or renal artery stenosis, vasculitis or systemic diseases like SLE should be considered.
Karakizlis
H
H
Klinik für Innere Medizin, Schwerpunkt Nephrologie, Universitätsklinikum Giessen und Marburg GmbH, Standort Marburg. karakizl@med.uni-marburg.de
Hoyer
J
J
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000959:Antihypertensive Agents; D001706:Biopsy; D001794:Blood Pressure / Q000187:drug effects; D001921:Brain / Q000473:pathology; D004630:Emergencies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D008279:Magnetic Resonance Imaging; D009122:Muscle Hypertonia / Q000209:etiology / Q000473:pathology; D009206:Myocardium / Q000473:pathology; D010956:Plasmapheresis; D055815:Young Adult
D000305:Adrenal Cortex Hormones; D000959:Antihypertensive Agents; D007166:Immunosuppressive Agents