Cerebral Embolism: A Challenging Complication In Libman-Sacks Endocarditis
DOI:
https://doi.org/10.48729/pjctvs.497Keywords:
Libman-Sacks endocarditis, marantic endocarditis, stroke, thrombosisAbstract
Libman-Sacks endocarditis is an uncommon disorder that can be a risk factor for neurocognitive dysfunction, and brain lesions, either separately or in a combination. We report 57-year-old woman from Colombia who presented with a history of dyspnea, associated with general malaise and arthralgia of small joints. On examination, she had signs of chronic arthropathy and purpuric plantar lesions. Her cardiac exam revealed a pan-systolic murmur of mitral regurgitation, harsh, grade 5/6, best heard at the apex, and a diastolic murmur in the aortic focus. Her echocardiography revealed severe mitral regurgitation and moderate aortic regurgitation with nodular thickening of both valves, consistent with a diagnosis of LSE. Blood cultures and serologic tests were negative. After starting anticoagulant treatment, the patient suffered a stroke, and it was finally decided that she would undergo surgery. She suffered a second stroke with status epilepticus in the immediate postoperative period. She eventually recovered without serious neurological sequelae.Downloads
References
Yoo BW, Lee SW, Song JJ, Park YB, Jung SM. Clinical characteristics and long-term outcomes of Libman-Sacks endocarditis in patients with systemic lupus erythematosus. Lupus. 2020 Aug;29(9):1115-1120.
Zuly S, Huttin O, Mohamed S, Marie PY, Selton-Suty C, Wahl D. Valvular heart disease in antiphospholipid syndrome. Curr Rheumatol Rep. 2013 Apr;15(4):320.
Lenz CJ, Mankad R, Klaich K, Kurmann R, McBane RD. Antiphospholipid syndrome and the relationship between laboratory assay positivity and prevalence of non-bacterial thrombotic endocarditis: A retrospective cohort study. J Thromb Haemost. 2020 Jun;18(6):1408-1414.
Roldan CA, Sibbitt WL, Qualls CR, Jung RE, Greene ER, Gasparovic CM, Hayek RA, Charlton GA, Crookston K. Libman-Sacks endocarditis and embolic cerebrovascular disease. JACC Cardiovasc Imaging. 2013 Sep;6(9):973-83.
RuDusby BM. Recurrent Osler's nodes in systemic lupus erythematosus. Angiology. 1969 Jan;20(1):33-7.
Riancho-Zarrabietia L, Martinez-Tabaeda VM, Rúa-Figueroa I, Alonso F, Galindo-Izquierdo M, Ovalles J, Olivé-Marqués A, Mena Vázquez N, Calvo-Alén J, Menor Almagro R, Tornero Muriel E, Uriarte Isacelaya E, Boteanu A, Andres M, Freire González M, Santos Soler G, Ruiz-Lucea ME, Ibáñez-Barcelo M, Castellví I, Galisteo C, Quevedo Vila V, Raya E, Narváez J, Expósito L, Hernández Berián JA, Horcada L, Aurrecoechea E, Pego Reigosa JM. Do all antiphospholipid antibodies confer the same risk for major organ involvement in systemic lupus erythematosus patients? Clin Exp Rheumatol. 2021 May-Jun;39(3):555-563.
Al-Jehani M, Al-Husayni F, Almagati A, Shahbaz J, Albugami S, Alameen W. A Case of Systemic Lupus Erythematosus in a Patient Presenting with Libman-Sacks Endocarditis. Case Rep Cardiol. 2021 Aug 31;2021:5573141. doi: 10.1155/2021/5573141. PMID: 34513093; PMCID: PMC8424240.
Le Ho Y, Ahmad Zaidi NA, Salleh A, Abdul Kareem BA. Aortic valve surgery for aortic regurgitation caused by Libman-Sacks endocarditis in a patient with primary antiphospholipid syndrome: a case report. J Cardiothorac Surg. 2021 Apr 17;16(1):92. doi: 10.1186/s13019-021-01458-2. PMID: 33865405; PMCID: PMC8052785.
Kousa O, Baskaran J, Ahmad A, Awad DH, Abbeata A. A Transesophageal Echocardiogram Finding: From Infection to Malignancy. Cureus. 2020 Feb 05;12(2):e6886.
Yamashita G, Kanemitsu N, Nakashima Y, Matsuo T, Nakane T, Honda M, Okabayashi H. Hypertrophic obstructive cardiomyopathy and mitral regurgitation in Libman-Sacks endocarditis. Gen Thorac Cardiovasc Surg. 2020 Feb;68(2):181-184.
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