Libman-Sacks endocarditis in a Bangladeshi patient suffering from rhupus

Area of Science:

• Cardiology
• Rheumatology
• Immunology

Background:

• Libman-Sacks endocarditis (LSE) is a characteristic cardiac manifestation of systemic lupus erythematosus (SLE).
• Symptomatic patients with LSE often experience systemic emboli, frequently associated with anti-phospholipid antibodies (aPA).
• The co-occurrence of LSE with rheumatoid arthritis (RA) and lupus, termed 'rhupus', is exceptionally rare.

Observation:

• This report details a rare case of a patient diagnosed with RA seven years prior.
• The patient had a history of an acute ischemic stroke one year before this evaluation.
• Echocardiography revealed evidence of LSE during routine assessment.

Findings:

• The patient presented with echocardiographic findings consistent with LSE.
• Despite the presence of LSE and a history of stroke, the patient tested negative for aPA.
• This case represents a rare instance of LSE in a patient with rhupus, lacking the typical aPA association.

Implications:

• This case expands the understanding of LSE presentation in autoimmune overlap syndromes.
• It suggests that LSE can occur in rhupus patients even without detectable anti-phospholipid antibodies.
• Further research may be needed to elucidate the specific pathogenic mechanisms of LSE in aPA-negative rhupus patients.