[Combination of Libman-Sacks endocarditis with infectious endocarditis]

Area of Science:

• Cardiology
• Rheumatology
• Infectious Diseases

Background:

• Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect multiple organs.
• Valvular heart lesions and endocarditis are known complications of SLE, with Libman-Sax endocarditis (LSE) being a specific manifestation.
• The interplay between LSE and secondary infectious endocarditis (IE) in SLE patients requires further investigation.

Observation:

• A 15-year study in Novosibirsk identified valvular lesions and endocarditis in 16.9% of 242 SLE patients.
• Three SLE patients (18-40 years) presented with a combination of LSE and IE.
• These patients exhibited polyorganic lupus pathology, lupus nephritis (Class IV), and high antiphospholipid antibody titers.

Findings:

• Secondary IE developed after intensive immunosuppressive therapy in SLE patients with LSE.
• The causative agents for IE were Staphylococcus (two patients) and Candida (one patient).
• Thromboembolic syndrome was present in SLE patients with concurrent IE.

Implications:

• LSE may mask the early signs of IE, necessitating vigilant monitoring.
• Approximately 10% of LSE patients are at risk for developing secondary IE.
• Prophylactic strategies are essential for SLE patients with hemodynamically significant LSE to prevent IE.