Case report UDC: 616-002.52:616.127-008 doi:10.5633/amm.2017.0306 CONDUCTION DISTURBANCES IN A WOMAN WITH SYSTEMIC LUPUS ERYTHEMATOSUS Jovana Cvetković 1 , Tomislav Kostić 2,3 , Jovan Nedović 1 , Sonja Stojanović 1,3 , Bojana Stamenković 1,3 , Dragana Stanojević 2 , Viktor Stoičkov 1,3 Cardiovascular involvement represents the leading cause of mortality in Systemic lupus erythematosus (SLE) patients. Its most common manifestations include pericarditis, valvular affections, conduction disorders, and arterial hypertension. Conduction disturbances are rare complication in the course of systemic lupus erythematosus. We describe the case of a woman with systemic lupus erythematosus and lupus cardio- myopathy who was admitted to our hospital due to dizziness showing on the electro- cardiogram Mobitz type II atrioventricular block and left anterior bundle branch block. This problem was resolved with a pacemaker implantation. Acta Medica Medianae 2017;56(3):38-41. Key words: systemiclLupus erythematosus, Mobitz type II atrioventricular block, pacemaker Institute for Treatment and Rehabilitation Niška Banja, Niška Banja, Serbia 1 Clinic of Cardiology, Clinical Center Niš, Niš, Serbia 2 University of Niš, Faculty of Medicine, Niš, Serbia 3 Contact: Jovana Cvetković Institute for Treatment and Rehabilitation, Niška Banja, Serbia E-mail: miljevicjovana@yahoo.com Introduction Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the pro- duction of autoantibodies, immune complex de- position, and heterogeneous clinical manifesta- tions. Cardiac involvement with systemic lupus erythematosus usually occurs in patients with an established diagnosis and typically involves the pericardium, myocardium, valves, and coronary vessels with conduction abnormalities being rare (1). Cardiovascular involvement is present in up to 50% cases (2) and it is associated with increased morbidity and mortality of SLE patients. Case report A female patient, 48 years old, was admit- ted to the Clinic for cardiovascular diseases, Clini- cal Center Niš, due to dizziness on 22 April, 2016. The patient was referred from a rheumatologist, who performed a detailed ambulatory examination and found bradycardia. Beside dizziness, the patient had pain in the hands and in the right shoulder. Physical examination showed discrete hyperemia of cheekbones, absence of active art- hritis, the Lazarević’s sign was negative, and aus- cultatory irregular and slow cardiac rhytms were found. On the ECG, the heart rate was 40/minute, with Mobitz type II atrioventricular block and left anterior bundle branch block (Figure 1). After hospital admission, we performed echocardio- graphy which showed that left ventricle ejection fraction was 62%, without significant abnorma- lities, except for a mild mitral regurgitation due to sclerotic mitral leaflets. Detailed medical history was taken. The first complaints patient had in 2002. She had a pain in the right hip and right leg, with pain and swelling of the elbows, shoulders, ankles and in the small joints of the hands and feet. Further, she was complaining of the morning stiffness lasting up to 15 minutes. In 2003, the diagnosis of rheumatoid arthritis was made and therapy with methotrexate www.medfak.ni.ac.rs/amm 38