Case 47-1976

Presentation of Case First admission. A 46-year-old black woman was admitted to the hospital because of abdominal pain and diarrhea.She was well until eight years previously, when a rash and arthralgia developed. Evaluation revealed impaired renal function and proteinuria, and tests for lupus erythematosus were strongly positive; prednisone was administered. Diabetes mellitus developed, and insulin was prescribed. Seven years before entry she was admitted to another hospital, where azathioprine was begun. Three years later she had an inferior myocardial infarct, and a year thereafter an anteroseptal myocardial infarct occurred, followed by congestive heart failure and anginal pain. Three . . .