Am J Med. Jul;(7) Libman-Sacks endocarditis in systemic lupus erythematosus: prevalence, associations, and evolution. Moyssakis I(1). Superadded bacterial endocarditis is rare but may be difficult to distinguish from The expanding spectrum of Libman Sacks endocarditis: the role of. Background. Libman-Sacks Endocarditis (LSE) affects patients with systemic lupus erythematosus (SLE) and positive antiphospholipid.

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In the setting of SLE, antiphosphilipid syndrome was considered. Transesophageal echocardiogram was done which showed echodense structures on the mitral valve consistent with endcoarditis or Libman Sacks endocarditis Figure 3. There was no sign of active dental infection. CRP is usually significantly elevated in endocarditls, although some elevation may also be seen in SLE disease activity.

There is an increased frequency of thromboembolic events among SLE patients in the setting of Libman Sacks endocarditis and antiphospholipid syndrome APS [ 2 ]. Clinical improvement was noted during hospital stay with completion of antibiotics, tapering of steroids, and continued anticoagulation.

Libman-Sacks endocarditis in systemic lupus erythematosus: prevalence, associations, and evolution.

This case report presents a female SLE patient with the above complications, confounded by the clinical setting sndocarditis infective endocarditis. June 25, Citation: This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Anticoagulation therapy was started using low-molecular weight heparin, tinzaparin.

Elevated antiphospholipid antibody titer is also more suggestive of SLE rather than infection. This article needs endocxrditis citations for verification. Cardiac fibrosis Heart failure Diastolic heart failure Cardiac asthma Rheumatic fever. Cardiovascular disease heart I00—I52— Please help improve this article by adding citations to reliable sources. During the follow-up period, of patients were reevaluated echocardiographically. Accelerated idioventricular rhythm Catecholaminergic polymorphic Torsades de pointes.


A repeat cranial MRI 3 weeks later was normal. Libmman-sacks Sacks endocarditis has small or medium-sized vegetations on either or both sides of the valve leaflets [ 7 ]. She was treated as cerebral thromboembolic disease with anticoagulation.

The pathology is the same as nonbacterial thrombotic endocarditis except focal necrosis with hematoxylin bodies can be found only in Libman—Sacks endocarditis. With the echocardiographic finding, she fulfilled 1 major criteria for infective endocarditis.

Libman–Sacks endocarditis

Two patients who were candidates for surgery died. Endocarditis infective endocarditis Subacute bacterial endocarditis non-infective endocarditis Libman—Sacks endocarditis Nonbacterial thrombotic endocarditis.

May 22, ; Accepted date: Ann Jose ankara escort. Penicillin and gentamycin were continued for 2 weeks. The mitral endofarditis is typically affected, and the vegetations occur on the ventricular and atrial surface of the valve.

The libman-saxks are small and formed from strands of fibrinneutrophilslymphocytesand histiocytes. Cranial MRI was repeated after 3 weeks which showed normal result. Echocardiographic studies have yet to be repeated as of writing this article. It is also known ebdocarditis verrucous, marantic, or non-bacterial thrombotic endocarditis. D ICD – Home Publications Conferences Register Contact. Libman-Sacks vegetations can be found in approximately 1 of 10 patients with systemic lupus erythematosus, and they are associated with lupus duration, disease activity, anticardiolipin antibodies, and antiphospholipid syndrome manifestations.

In cases such as this, it may be prudent to treat both conditions with the recommended antibiotic regimen and prolonged anticoagulation.

We evaluated the prevalence and progression of Libman-Sacks endocarditis in patients with systemic lupus erythematosus and any association between this valvulopathy and their clinical and laboratory characteristics. She has had recurrent throat and gingival infections in the past year treated with antibiotics.


She also presented with a heart murmur suggestive of cardiac valvular disease also confirmed by ultrasonographic studies. Libman Sack lesions are associated with lupus duration, disease activity, anti-cardiolipin antibodies, and antiphospholipid syndrome [ 5 ].

TEE showing mitral valve vegetation. One patient had mild tricuspid regurgitation.

Libman-Sacks endocarditis in systemic lupus erythematosus: prevalence, associations, and evolution.

Valvular heart disease Systemic connective tissue disorders. It is one of the most common heart-related manifestations of lupus the most common being pericarditis.

She remained afebrile throughout the hospital stay and her diplopia progressively improved.

These subendothelial deposits may eventually lead to deformed valves. Select your language of interest to view the total content in your interested language. Characteristic valvular pathology can also distinguish infective endocarditis vegetations from Libman Sacks endocarditis but this may not always hold true as vegetative lesions may evolve throughout the course libmwn-sacks the disease.

In 24 of 38 patients, mitral valve involvement was found, resulting in regurgitation in all mild in 18, moderate in 4, and severe in 2whereas stenosis co-occurred with regurgitation in 9 patients mild in 6 and moderate in 3. Laboratory parameters can also be useful in distinguishing infective endocarditis from Libman Sacks endocarditis.

The most commonly involved valve is the mitral valve followed by the aortic valve.