April 1982

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

Author Affiliations

From the Departments of Cardiology (Dr Talano) and Rheumatology (Drs Bomalaski and Perlman), Northwestern University Medical School and Northwestern Memorial Hospital, Chicago.

Arch Intern Med. 1982;142(4):823-824. doi:10.1001/archinte.1982.00340170183028

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

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