The autoimmunity conundrum: clotting or inflammation

Antiphospholipid syndrome (APS) is an autoimmune condition with a myriad of clinical manifestations ranging from cardiovascular, neurologic, renal involvement to cutaneous manifestations and thrombocytopenia. We describe a young woman who presented with fever, cough and dyspnea. She had a history of recurrent pregnancy losses and her antiphospholipid antibodies and lupus serologies were positive. Echocardiography showed mobile mitral and aortic valve vegetations. She was treated as for infective endocarditis and diagnosed with primary APS with lupus-like disease. Vigilance is required to establish if there is an underlying rheumatological condition in a patient who presents with presumptive infective endocarditis in the absence of risk factors. Treatment for systemic lupus erythematosus and primary APS are distinct.