SHM Converge Scientific Abstract ePoster Gallery-Caught Red-Handed: Systemic Lupus Erythematosus Masquerading as Peripheral Artery Disease

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This case highlights the difficulty of diagnosing digital ischemia in a patient with both systemic lupus erythematosus (SLE) and advanced peripheral artery disease (PAD). Although arterial duplex ultrasound suggested severe large-vessel compromise, angiography showed the major arteries were patent, with poor filling of the digital arteries. This discrepancy suggested small-vessel lupus vasculopathy rather than worsening PAD.<br /><br />The patient’s serologic findings were consistent with an SLE flare, further supporting microvascular involvement. Because treatment differs greatly between the two conditions, correctly distinguishing PAD-related ischemia from SLE-associated vasculopathy was essential. PAD-related ischemia would not be expected to improve with immunosuppression, while lupus vasculopathy can worsen rapidly without it.<br /><br />The patient was initially treated with heparin and vasodilators, then received pulse-dose corticosteroids followed by a prednisone taper. Symptoms stabilized, and no tissue loss occurred. Early steroid treatment may have prevented digital necrosis, which has been reported in untreated lupus vasculitis.<br /><br />The case emphasizes that abnormal vascular studies should not automatically be attributed to progression of PAD, especially in the setting of active lupus. Clinicians should consider small-vessel disease when duplex ultrasound and angiography do not match. Awareness of the limitations of these imaging tests can help avoid misdiagnosis and prevent irreversible tissue loss.

Asset Subtitle

Daniela Sainz-Jacobo

Meta Tag

Author List Akshay Gunturu, Ashwin Senthilrajan, Daniela Sainz-Jacobo, Julio Zavala-Georffino, Klarissa A. Saldivar, Luis Corral-Guerrero

Category Clinical Vignettes

Concept Digital Ischemia

Concept Systemic Lupus Erythematosus

Concept Small-Vessel Vasculopathy

Concept Peripheral Arterial Disease

Concept Microvascular Disease

Distinguished Non-Finalist

Presenter Organization University of the Incarnate Word

Presenting Author Daniela Sainz-Jacobo

Track Adult

Keywords

systemic lupus erythematosus

digital ischemia

peripheral artery disease

lupus vasculopathy

small-vessel disease

angiography

arterial duplex ultrasound

microvascular involvement

corticosteroids

digital necrosis

Digital Ischemia

Systemic Lupus Erythematosus

Small-Vessel Vasculopathy

Peripheral Arterial Disease

Microvascular Disease