Endovascular stent-graft placement for ruptured dissecting aortic aneurysm in an adolescent patient with systemic lupus erythematosus: case report

Abstract

Systemic lupus erythematosus (SLE) is a chronic autoimmune connective tissue disease with multi-organ involvement that is associated with the presence of autoantibodies, and it is influenced by genetic, endocrine, or environmental backgrounds such as exposure to ultraviolet rays and viral infections for the etiopathogenesis [1]. In the cardiovascular system, it frequently causes pericarditis, nonbacterial verrucous endocarditis, coronary artery disease, and cardiomyopathy [2]. Cardiovascular complications in SLE are generally presumed to be associated with inflammatory activity as well as premature development of atherosclerosis [1]. The overall morbidity and death from these complications have been increasing in recent years, and they are now the major cause of death in SLE [3]. Dissecting aortic aneurysm in SLE has been recognized as a rare life-threatening complication, but its pathogenesis is still obscure. The pathogenesis of aortic aneurysms and dissection in SLE has been attributed to aortic circulatory disturbances resulting from vasculitis and cystic medial degeneration as well as to atherosclerosis. The occurrence of atherosclerosis is considered to be due to long-term steroid treatment, hyperlipidemia, hypertension, and nephrotic syndrome [4]. The importance of the high prevalence of premature atherosclerosis and cardiovascular disease in SLE should be addressed, even in young adolescents, and especially those with early childhood-onset disease. Nevertheless, aortic dissection is a life-threatening disorder that requires immediate diagnosis and treatment to prevent mortality. To our knowledge, this is the second adolescent patient with childhood-onset SLE complicated with aortic dissection, but the first case treated with endovascular stent-grafting.