Hemoptysis and a cardiac murmur: is it primary or secondary antiphospholipid syndrome?

Area of Science:

• Cardiology
• Rheumatology
• Pathology

Background:

• Systemic lupus erythematosus (SLE) is associated with significant cardiovascular morbidity, including valvular disease and non-infective endocarditis (Libman-Sacks endocarditis).
• Antiphospholipid syndrome (APS) increases the prevalence of Libman-Sacks syndrome in SLE patients.
• Non-infective endocarditis and diffuse alveolar hemorrhage are rare but serious manifestations.

Observation:

• A patient with primary antiphospholipid syndrome presented with hemoptysis and a cardiac murmur.
• Clinical findings included non-infective verrucous vegetations and diffuse alveolar hemorrhage.
• These findings led to the diagnosis of SLE with secondary APS.

Findings:

• Treatment with high-dose corticosteroids and intravenous immunoglobulins resulted in resolution of cardiac vegetations and regression of diffuse alveolar hemorrhage.
• Aortic valve replacement was successfully performed electively with no postoperative complications.
• The patient achieved remission after a 6-month follow-up.

Implications:

• This case highlights the importance of considering SLE in patients with primary APS presenting with cardiac and pulmonary manifestations.
• Prompt diagnosis and multidisciplinary management are crucial for favorable outcomes.
• Understanding the link between SLE, APS, and non-infective endocarditis can improve patient care and treatment strategies.