# Localized ST Elevations and PR Depressions in Systemic Lupus Erythematosus Pericarditis: An Unusual Case Presentation

## TL;DR

A 49-year-old man with SLE showed unusual ECG changes suggesting pericarditis, not heart attack, highlighting the role of ultrasound in diagnosis.

## Contribution

This case demonstrates localized ECG changes in SLE-related pericarditis, emphasizing the use of POCUS for accurate diagnosis.

## Key findings

- Localized ST elevations and PR depressions in inferior leads were observed in SLE-associated pericarditis.
- POCUS and TTE helped differentiate pericarditis from acute coronary syndrome despite atypical ECG findings.
- Treatment with NSAIDs, steroids, and immunomodulators resolved the pericarditis.

## Abstract

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with frequent cardiac involvement. A 49‐year‐old male with a 20‐year history of SLE presented with a rash and lip swelling concerning for angioedema versus anaphylaxis. During bedside rounds, point‐of‐care‐ultrasound (POCUS) revealed a small posterior pericardial effusion, prompting a formal transthoracic echocardiogram (TTE). He subsequently developed acute substernal chest pain with ECG findings of isolated ST elevations and PR depressions, in the inferior leads (II, III, and aVF). Despite concerns for acute coronary syndrome (ACS), the team was reassured by POCUS, TTE, and negative troponins. He was diagnosed with SLE‐associated pericarditis and treated with NSAIDs, steroids, hydroxychloroquine, and methotrexate. This case highlights the importance of utilizing POCUS and physical examination skills to differentiate SLE‐associated pericarditis from ACS, particularly when ECG findings present in a localized, non‐diffuse pattern.