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A 19-Year-Old Woman Comes to the Emergency Department Due to a 4-5-Day

question 35

Multiple Choice

A 19-year-old woman comes to the emergency department due to a 4-5-day history of chest discomfort that radiates to the nuchal fold and shoulders bilaterally. The patient took over-the-counter ibuprofen and had some pain relief. She reports associated fatigue and bilateral knee pain yesterday, which has since resolved. The patient has a history of systemic lupus erythematosus, for which she takes hydroxychloroquine. She does not smoke or take illicit drugs. The patient has no family history of cardiovascular diseases. Temperature is 38.3 C (100.9 F) , and blood pressure is 110/70 mm Hg in the upper extremities bilaterally. Examination shows an erythematous rash over the cheeks and the nasal bridge. Pain is not reproducible with chest palpation. A superficial scratchy sound is heard between S1 and S2. Breath sounds are normal. ECG reveals sinus tachycardia at 103/min and diffuse T wave inversion. Laboratory results are as follows: Serum troponin drawn on presentation is <0.01 ng/dL. Which of the following is the most likely explanation for this patient's symptoms?

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