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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
PubMed

Insights

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.

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.

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