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Infective endocarditis management involves a multifaceted approach encompassing infection prevention, lifestyle modifications, pharmacological therapy, and surgical management.Infection Prevention:Hand Hygiene: Thorough handwashing is crucial to prevent the spread of infection. Hand hygiene should be performed regularly, especially before and after using the restroom.Oral Hygiene: Good oral hygiene is essential. It includes brushing teeth immediately after waking up and before bed, flossing...
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Mitral stenosis, a condition marked by the narrowing of the mitral valve, necessitates an integrated approach for effective management. This approach includes preventative measures, medical therapy, and surgical interventions to reduce symptoms and prevent complications.PreventionPrevention of mitral stenosis primarily focuses on reducing the incidence of bacterial infections, particularly streptococcal infections, which can lead to rheumatic fever and subsequent valvular damage. Timely...
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Aortic valve replacement for Libman-Sacks endocarditis.

Jack B Keenan1, Taufiek Konrad Rajab, Rajesh Janardhanan2

  • 1Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA.

BMJ Case Reports
|October 6, 2016
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Summary
This summary is machine-generated.

Systemic lupus erythematosus and antiphospholipid syndrome can cause non-bacterial thrombotic endocarditis, leading to aortic valve vegetations and limb ischemia. This case highlights the importance of considering NBTE in patients with autoimmune conditions presenting with embolic events.

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Area of Science:

  • Cardiology
  • Rheumatology
  • Pathology

Background:

  • Systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) are autoimmune disorders associated with thrombotic complications.
  • Lupus nephritis, a renal manifestation of SLE, can further increase thromboembolic risk.
  • Acute limb ischemia is a critical manifestation of embolic events, necessitating urgent diagnosis and management.

Observation:

  • A 24-year-old male with SLE and APS, complicated by lupus nephritis, presented with acute limb ischemia due to an embolus.
  • Transthoracic echocardiogram revealed large vegetations on all three aortic valve cusps.
  • Urgent aortic valve replacement was performed.

Findings:

  • Histopathological examination of the aortic valve cusps revealed sterile, fibrin-rich thrombotic vegetations.
  • These findings are characteristic of non-bacterial thrombotic endocarditis (NBTE).
  • Cultures from one cusp were sterile, supporting a non-infectious etiology.

Implications:

  • This case underscores NBTE as a potential complication in patients with SLE and APS, particularly those with lupus nephritis.
  • NBTE can manifest as embolic phenomena, including acute limb ischemia.
  • Early recognition and management of NBTE are crucial in patients with underlying autoimmune and thrombotic disorders.