DOI: https://doi.org/10.36347/sjmcr.2026.v14i03.008

Pages: 348-351

Background: Spontaneous Coronary Artery Dissection (SCAD) is the leading cause of acute coronary syndrome (ACS) in women under 50. While Systemic Lupus Erythematosus (SLE) is a recognized cause of vascular fragility, it is classically associated with overt mucocutaneous or musculoskeletal symptoms. SCAD occurring as the sole, inaugural manifestation of "silent" SLE represents a major diagnostic pitfall. Case Presentation: We report the case of a 36-year-old female, non-smoker with moderate obesity (BMI 31 kg/m²), admitted for acute retrosternal chest pain. Electrocardiogram showed anterior ischemic changes consistent with NSTEMI. Coronary angiography revealed a Type 1 SCAD of the Left Anterior Descending (LAD) artery. Despite the patient fitting the "typical" demographic profile for idiopathic SCAD, a systematic etiological workup was performed. Surprisingly, while the patient had no history of rash, photosensitivity, or arthralgia, immunological testing was strongly positive for Antinuclear Antibodies (ANA 1:640) and anti-dsDNA, confirming active SLE. Management: The patient was managed conservatively for the dissection (Beta-blockers, Aspirin) and initiated on specific immunosuppressive therapy (Corticosteroids, Hydroxychloroquine) to treat the underlying vascular inflammation. The outcome was favorable with no recurrence at 3 months. Conclusion: This case challenges the common practice of labeling SCAD as "idiopathic" in young women without obvious comorbidities. It supports the systematic screening for connective tissue diseases, as unmasking an occult Lupus drastically alters long-term management and prognosis.