Lupus-Negative Libman-Sacks Endocarditis Complicated by Catastrophic Antiphospholipid Syndrome

Murtaza, Ghulam; Iskandar, Joy; Humphrey, Tara; Adhikari, Sujeen; Kuruvilla, Aneesh

doi:10.14740/cr534e

Cited by 13 publications

(12 citation statements)

References 16 publications

(17 reference statements)

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Section: Discussionmentioning

confidence: 99%

“…Libman and Sacks described valvular disease due to SLE for the first time in 1924 [ 1 , 3 , 5 ]. LSE is sterilized vegetation that mostly affects the mitral valves and possibly the aortic valve [ 3 , 5 ]. It may present as infective endocarditis with symptoms of heart failure due to valvular regurgitation and thromboembolic events [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

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All Endocarditis Is Not Infective: Libman-Sacks Endocarditis

Riyami¹,

Joshi²,

Senaidi³

et al. 2022

Cureus

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Libman-Sacks endocarditis (LSE) is an uncommon disorder that might be confused with infective endocarditis. It is one of the systemic lupus erythematosus (SLE) manifestations that could present with heart failure. We report a 12-year-old girl who presented with a history of shortness of breath, joint pain for four weeks, and fever for about one week. On examination, she was pale, edematous, and febrile. Her cardiac exam revealed a pan-systolic murmur of mitral regurgitation, harsh, grade 3/6 best heard at the apex. She was diagnosed with systemic lupus erythematosus with lupus nephritis and carditis. Her echocardiography revealed severe mitral regurgitation with nodular thickening of the valve in keeping with a diagnosis of LSE. After appropriate management of her underlying disorder using immunosuppressive, we saw a dramatic clinical improvement and her heart failure symptoms resolved. This case proves that SLE can have significant cardiac involvement and a proper evaluation would help in overall management and prognosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

All Endocarditis Is Not Infective: Libman-Sacks Endocarditis

Riyami¹,

Joshi²,

Senaidi³

et al. 2022

Cureus

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“…Libman-Sacks endocarditis (a form of NBTE), which has been shown to be associated with SLE, can also be associated with APS [ 5 ]. This suggests that antiphospholipid antibodies may be involved in the pathogenesis of heart valve damage.…”

Section: Reviewmentioning

confidence: 99%

“…NBTE can occur due to mechanical stress, chemical agents, and from immunological conditions (autoimmune diseases) such as systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). Blood culture-negative endocarditis accounts for 2.5 percent to 31 percent of all cases of endocarditis [ 5 ]. Although uncommon, it is frequently underestimated in the clinical setting due to its atypical presentation.…”

Section: Introductionmentioning

confidence: 99%

A Review of Cardiac Manifestations in Patients With Systemic Lupus Erythematosus and Antiphospholipid Syndrome With Focus on Endocarditis

Tayem¹,

Shahin²,

Shook³

et al. 2022

Cureus

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Patients with autoimmune diseases such as systemic lupus erythematosus (SLE) or antiphospholipid syndrome (APS) are at a higher risk for adverse cardiovascular events associated with increased morbidity and mortality. The increased risk of these events is often associated with rheumatic heart disease (heart valve or mural endocardium damage from rheumatic fever) following microbial infection (i.e., untreated or under-treated streptococcal infection). In particular, the weakening of cardiac vasculature due to rheumatic heart disease makes such patients with autoimmune diseases more susceptible to endocarditis. Endocarditis can be caused by an infection (infective endocarditis) or inflammation tied to disease activity (non-bacterial thrombotic endocarditis [NBTE]). Infective endocarditis among patients with autoimmune diseases may result from exposure to pathogens during dental or surgical procedures. NBTE commonly occurs as a result of fibrin and platelet aggregation on the cardiac valves without bacterial infection. While diagnosis and management can vary based on underlying etiology, an interdisciplinary approach that includes prevention and management from dentists, cardiologists, rheumatologists, and primary care physicians is needed. In addition, increasing patient and physician education on risk factors and prevention strategies is much needed. This manuscript will review the pathophysiology of endocarditis, the association between SLE and APS and endocarditis risk, the diagnosis and management of these autoimmune diseases with a focus on the prevention of cardiovascular disease risk, and make recommendations for diagnostic and management approaches to improve care.

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“…Causes of ME can be inflammatory, autoimmune or malignant [3]. ME commonly affects the MV [4] and presents with embolic phenomena [5]. ME vegetations typically attach firmly to valve leaflets and move with them compared to independently-mobile infective vegetations [6].…”

mentioning

confidence: 99%

441 An Atypical Case of Marantic Endocarditis in Undiagnosed Antiphospholipid Syndrome

Yao

Joshi

Morgan

et al. 2020

Heart, Lung and Circulation

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Background: The acute withdrawal of beta-blockers is known to precipitate sympathetic hyperresponsiveness. The use of these agents during acute exacerbations of chronic obstructive pulmonary disease (COPD) appears to be safe, however, there is ongoing concerns of their adverse respiratory effects. The true clinical impacts of the acute withdrawal of beta-blockers during these periods of systemic inflammation and respiratory distress are unknown. Method: A retrospective cohort study of patients that were hospitalised for acute exacerbations of COPD across two tertiary centres in Melbourne, Australia, over a 12-month period. Patient demographics, inpatient medication use, cardiac and respiratory outcomes were recorded. Results: 1071 patients met the inclusion criteria, of which, 276 patients (25.8%) were taking beta-blockers on admission. Of these, 23 (8.2%) had beta-blockers acutely ceased during admission. The most common indication for cessation was hypotension (12/23, 52.1%), followed by respiratory distress (8/23, 34.8%). Compared to those that continued beta-blockers throughout admission, acute withdrawal was associated with increased rates of atrial fibril

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Lupus-Negative Libman-Sacks Endocarditis Complicated by Catastrophic Antiphospholipid Syndrome

Cited by 13 publications

References 16 publications

All Endocarditis Is Not Infective: Libman-Sacks Endocarditis

All Endocarditis Is Not Infective: Libman-Sacks Endocarditis

A Review of Cardiac Manifestations in Patients With Systemic Lupus Erythematosus and Antiphospholipid Syndrome With Focus on Endocarditis

441 An Atypical Case of Marantic Endocarditis in Undiagnosed Antiphospholipid Syndrome

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