JACC Case Rep. 2026 Oct 8:110239. doi: 10.1016/j.jaccas.2026.110239. Online ahead of print.
ABSTRACT
Cardiovascular disease is a major cause of morbidity and mortality in systemic lupus erythematosus (SLE). Although accelerated atherosclerosis is well recognized, SLE-related coronary vasculitis and microvascular injury remain underdiagnosed. Cardiac magnetic resonance (CMR) offers unique tissue characterization that may reveal atypical patterns of myocardial injury. We describe 2 patients with active SLE who presented with acute cardiac symptoms and elevated cardiac biomarkers. CMR demonstrated both classic inflammatory findings of lupus myopericarditis (subepicardial late gadolinium enhancement and pericardial enhancement) and vascular-appearing injury, including transmural and subendocardial late gadolinium enhancement. In 1 case, coronary vascular injury occurred in the setting of systemic infection and macrophage activating syndrome, whereas in the other, coronary angiography showed normal coronary arteries, supporting a nonatherosclerotic mechanism such as coronary vasculitis or microvascular thrombosis. Serial CMR demonstrated improvement following immunosuppressive therapy. CMR can identify mixed myocardial injury phenotypes in SLE, providing critical diagnostic and follow-up information beyond conventional imaging.
PMID:42853173 | DOI:10.1016/j.jaccas.2026.110239