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A 49\u2010year\u2010old male with a 20\u2010year history of SLE presented with a rash and lip swelling concerning for angioedema versus anaphylaxis. During bedside rounds, point\u2010of\u2010care\u2010ultrasound (POCUS) revealed a small posterior pericardial effusion, prompting a formal transthoracic echocardiogram (TTE). He subsequently developed acute substernal chest pain with ECG findings of isolated ST elevations and PR depressions, in the inferior leads (II, III, and aVF). Despite concerns for acute coronary syndrome (ACS), the team was reassured by POCUS, TTE, and negative troponins. He was diagnosed with SLE\u2010associated pericarditis and treated with NSAIDs, steroids, hydroxychloroquine, and methotrexate. This case highlights the importance of utilizing POCUS and physical examination skills to differentiate SLE\u2010associated pericarditis from ACS, particularly when ECG findings present in a localized, non\u2010diffuse pattern.<\/jats:p>","DOI":"10.1155\/carm\/6633318","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T08:29:37Z","timestamp":1771316977000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Localized ST Elevations and PR Depressions in Systemic Lupus Erythematosus Pericarditis: An Unusual Case Presentation"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-2282-5802","authenticated-orcid":false,"given":"Evan","family":"Derector","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Madhurima S.","family":"Gundlapally","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas R.","family":"Young","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,2,17]]},"reference":[{"key":"e_1_2_9_1_2","unstructured":"Justiz VaillantA. 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