A Case of Lupus Myopericarditis in a Young African American Male

A 28-year-old African American male presented to the emergency department with a chief complaint of chest pain. He stated that the pain began five days prior to arrival and had not improved despite taking ibuprofen and self-medicating with marijuana. His chest pain was constant and localized to the center of his chest, rating it as a 7/10 in terms of severity. His past medical history included a diagnosis of systemic lupus erythematosus (SLE) three months ago, complicated by pericarditis, for which he had been taking colchicine and prednisone, as well as hydroxychloroquine for maintenance therapy. He stated that he adhered to his treatment regimen without missing a single dosage. Upon cardiac auscultation, he was found to have a pericardial friction rub. His ECG showed signs of PR-segment depression in all leads, ST-elevation in leads V2-V4, as well as sinus tachycardia, raising some concern for myocardial ischemia. His echocardiogram showed no signs of pericardial effusion or left ventricular dysfunction and was otherwise unremarkable. Because of his positional chest pain, diffuse ST-elevation, and elevated troponin, the patient was diagnosed with myopericarditis, thought to be secondary to SLE exacerbation due to no recent illnesses. He was then placed on low-dose prednisone. After four days, his symptoms resolved, and he was discharged with a regimen of 60 mg prednisone daily and 0.5 mg colchicine daily for his pericarditis as well as 10 mg oxycodone for his pain every eight hours. His prednisone was to be tapered with a rheumatologist outpatient, but there was no follow-up at the time of writing this study.