Improvement of Libman-Sacks Endocarditis With Combined Hydroxychloroquine-Vitamin K Antagonist Therapy in a Primary Antiphospholipid Syndrome Patient

Omarjee, Loukman; Jaquinandi, Vincent; Camarzana, Audrey; Rouleau, Frédéric; Mezdad, Tin-Hinan; Tourneau, Thierry Le; Bélizna, C.

doi:10.1253/circj.cj-17-1131

Cited by 4 publications

(3 citation statements)

References 6 publications

(9 reference statements)

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“…In distinction to the aforementioned studies, this report shows that a short course of high-dose steroids may be beneficial at mitigating vegetation growth without causing valvular damage. Our patient also received hydroxychloroquine, which is reportedly associated with good outcomes in patients with SLE and LSE due to its anti-inflammatory and antithrombotic properties (8) .…”

Section: Discussionmentioning

confidence: 85%

Ischemic Stroke From Libman-Sacks Endocarditis Not Associated With Antiphospholipid Antibodies

2019

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Libman-Sacks endocarditis (LSE), a cardiac complication of systemic lupus erythematosus, is commonly treated with anticoagulation for stroke prevention. We describe a patient with multifocal strokes secondary to LSE, treated with aspirin, without further recurrence. Our case highlights the importance of nuanced decision-making regarding antithrombotic choices for stroke prevention in LSE. ( Level of Difficulty: Intermediate. )

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Section: Discussionmentioning

confidence: 85%

Ischemic Stroke From Libman-Sacks Endocarditis Not Associated With Antiphospholipid Antibodies

2019

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“…Our patient was not a candidate for continued medical management due to the severity of his heart failure, as well as an observed lability on warfarin which made it difficult to maintain INR at a therapeutic value. However, recent case reports have shown complete resolution of an aortic valve thrombus with warfarin [ 10 ], as well as resolution of TV NBTE in a patient managed with vitamin K antagonists-hydroxychloroquine (VKA-HCQ) [ 11 ]. Clinical trials are still necessary to further evaluate said treatment options and develop more robust therapies for NBTE in patients with APS.…”

Section: Discussionmentioning

confidence: 99%

Nonbacterial Thrombotic Endocarditis of the Tricuspid Valve in a Male Patient with Antiphospholipid Syndrome

Yordan-Lopez

Hernández-Suárez

Marshall-Perez

et al. 2018

Cureus

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Valve vegetations in nonbacterial thrombotic endocarditis consist of fibrin and platelet aggregates and can be related to circulating immune complexes, such as in the case of antiphospholipid syndrome. In patients with primary antiphospholipid syndrome, echocardiographic studies have disclosed heart valve abnormalities in about a third of patients. Unusual associations between antiphospholipid syndrome and nonbacterial thrombotic endocarditis include presentation as an intracardiac mass compatible with a myxoma on imaging studies, as well as isolated involvement of the tricuspid valve. Both of these scenarios have been previously reported in female patients. This article presents the case of a 53-year-old Hispanic male with antiphospholipid syndrome who presented to the hospital with symptoms of heart failure and persistent right calf pain. An intracardiac mass attached to the anterior leaflet of the tricuspid valve was found through transthoracic echocardiography. Further imaging studies suggested the mass to be a myxoma and the patient underwent mass excision with tricuspid valve replacement. Pathology report of the surgical specimen was consistent with a diagnosis of nonbacterial thrombotic endocarditis. This case highlights the importance of considering nonbacterial thrombotic endocarditis as a key differential diagnosis in patients with concomitant antiphospholipid syndrome and intracardiac masses, as well as challenges encountered in diagnosis and management.

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“…This suggests that the management and therapeutic strategies for children with LSE and antiphospholipid antibody positivity differ from those in adult patients (21). Furthermore, several adult case studies have previously demonstrated that LSE can be resolved or improved by the administration of immunosuppressive medications in conjunction with antithrombotic and hydroxychloroquine therapy (3,(22)(23)(24)(25)(26). However, the specific time range during which LSE vegetation can disappear after early active treatment, which requires future multicenter clinical validation, has not yet been documented in the literature.…”

Section: Daymentioning

confidence: 99%

Libman-Sacks endocarditis in a child with systemic lupus erythematosus: a case report and literature review

Lu,

Bao,

et al. 2024

Front. Pediatr.

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Libman-Sacks endocarditis (LSE) is a cardiac condition characterized by the growth of verrucous vegetation. Although relatively rare in children, LSE is nevertheless a known cardiac manifestation of autoimmune diseases, including systemic lupus erythematosus (SLE). The mitral valve is the most commonly affected region, followed by the aortic valve, while the tricuspid and pulmonary valves are rarely affected. The management of established Libman-Sacks vegetation poses significant challenges, often necessitating surgical interventions, although surgery is not the primary treatment modality. Herein, we present the case of a 14-year-old Chinese female patient whose initial lupus manifestation included LSE, among other symptoms and signs that provided insights into the final diagnosis of SLE. After early comprehensive pharmacological treatment, tricuspid regurgitation and vegetation disappeared within 28 days without necessitating cardiac surgery, indicating that the resolution of LSE vegetation in this patient was achieved through a combination of immunosuppressive and anticoagulant therapy. These findings suggest the potential of this treatment approach as a viable model for the management of LSE in young patients.

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Improvement of Libman-Sacks Endocarditis With Combined Hydroxychloroquine-Vitamin K Antagonist Therapy in a Primary Antiphospholipid Syndrome Patient

Abstract: Figure. IMAGES IN CARDIOVASCULAR MEDICINEAdvance Publication by-J-STAGE

Cited by 4 publications

References 6 publications

Ischemic Stroke From Libman-Sacks Endocarditis Not Associated With Antiphospholipid Antibodies

Ischemic Stroke From Libman-Sacks Endocarditis Not Associated With Antiphospholipid Antibodies

Nonbacterial Thrombotic Endocarditis of the Tricuspid Valve in a Male Patient with Antiphospholipid Syndrome

Libman-Sacks endocarditis in a child with systemic lupus erythematosus: a case report and literature review

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