[Pseudoinfectious endocarditis].

Area of Science:

• Cardiology
• Pathology
• Rheumatology

Context:

• Nonbacterial thrombotic endocarditis (PIE) is characterized by sterile thrombus formation on heart valves.
• It frequently affects mitral and aortic valves, with vegetations prone to embolism.
• Hypercoagulation is a key factor in PIE pathogenesis.

Purpose:

• To describe the characteristics, causes, and diagnostic challenges of nonbacterial thrombotic endocarditis.
• To highlight the role of antiphospholipid antibodies in valve pathology in antiphospholipid syndrome and systemic lupus erythematosus.
• To outline the primary diagnostic and therapeutic strategies for PIE.

Summary:

• The most common acquired causes of sterile vegetations are malignant tumors and rheumatic diseases, particularly antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE).
• Valve pathology is a frequent cardiac manifestation in APS, with antibodies to phospholipids (aPL) implicated in pathogenesis.
• Recurrent thromboembolism, valve dysfunction, and diagnostic difficulties (especially with fever) are major clinical issues.
• Transesophageal echocardiography is the leading diagnostic tool.

Impact:

• This understanding aids in the differential diagnosis of endocarditis, especially in patients with underlying malignancy or autoimmune conditions.
• Effective management relies on identifying and treating the underlying cause and initiating anticoagulant therapy.
• Early diagnosis and treatment can mitigate risks of severe complications like heart failure and recurrent embolism.