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Giant coronary aneurysm presenting as acute coronary syndrome in a patient with systemic lupus erythematosus

We report the case of a 30-year-old woman who presented to the emergency department with rest angina on a background of 3-year history of active systemic lupus erythematosus (SLE) with lupus nephritis on immunosuppressants and steroids. The patient had no evidence of cardiac disease. General examination revealed moderate pallor, whereas systemic examination revealed an early diastolic murmur in the aortic area and bilateral basal crepitations. There were no peripheral signs of aortic regurgitation. The ECG showed ST segment depressions with T inversions in anterior precordial leads (V1–V6). Echocardiography revealed moderate aortic regurgitation (figure 1) with anterolateral wall hypokinesia and moderate left …