DOI: https://doi.org/10.36347/sjmcr.2026.v14i10.009

Pages: 2159-2164

Coronary artery aneurysm (CAA) is an extremely rare cardiovascular manifestation of systemic lupus erythematosus (SLE) and may coexist with premature diffuse coronary artery disease (CAD), resulting in significant morbidity and mortality. We report a young female patient with quiescent SLE who presented with acute coronary syndrome secondary to giant CAA and diffuse triple-vessel CAD. This case highlights the importance of early recognition and multidisciplinary management of this uncommon but potentially lifethreatening complication. Case Presentation: A 38-year-old, non-smoking woman with a 4-year history of quiescent SLE, maintained on hydroxychloroquine, presented with sudden-onset chest discomfort and dyspnoea. Physical examination revealed no significant cardiovascular abnormalities or clinical evidence of an acute SLE flare. Troponin I was elevated, while electrocardiography demonstrated T-wave inversion and ST-segment depression in the anteroseptal and lateral leads (V1–V5), consistent with non-ST-elevation acute coronary syndrome. Computed tomography coronary angiography and invasive coronary angiography demonstrated extensive coronary calcification, diffuse triple-vessel CAD, and multiple CAAs, including a giant aneurysm involving the distal left main coronary artery at the polygon of confluence. There was also chronic total occlusion of the mid-right coronary artery and distal left anterior descending artery. Transthoracic echocardiography demonstrated preserved left ventricular systolic function (left ventricular ejection fraction, LVEF 55%) with no significant valvular abnormalities. Laboratory investigations, including complete blood count, renal function, liver function, urinalysis, complement levels (C3 and C4), and lipid profile, were within normal limits. Following preoperative intravenous methylprednisolone (MTP) pulse therapy, the patient underwent coronary artery bypass grafting (CABG), coronary endarterectomy, and plication of the proximal LAD