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Mitral valve replacement due to Libman-Sacks endocarditis: lower limb cellulitis as a red herring
Gerard Sexton1, Joseph McLoughlin2, Louise Burke3
1General Medicine, Mercy University Hospital, Cork, Ireland gerardsexton@rcsi.ie.
BMJ Case Reports
|January 21, 2022
Summary
Antiphospholipid syndrome can cause valve lesions mimicking infective endocarditis. This case highlights the importance of considering autoimmune conditions in patients with suspected heart valve infections.
Area of Science:
- Cardiology
- Rheumatology
- Vascular Medicine
Background:
- Antiphospholipid syndrome (APS) is an autoimmune disorder associated with an increased risk of thrombosis and pregnancy complications.
- Patients with APS can present with various clinical manifestations, including vascular events and cardiac involvement.
- Distinguishing APS-related cardiac lesions from infective endocarditis is crucial for appropriate management.
Observation:
- A 56-year-old woman with chronic leg ulcers presented with acute digital ischemia and new ulcerations.
- Laboratory tests revealed strongly positive lupus anticoagulant and elevated anticardiolipin antibodies, confirming APS.
- Echocardiography showed a mitral valve lesion with mild regurgitation, initially suspected as vegetation.
Findings:
- Despite negative blood cultures and sterile excised valve tissue, the mitral valve lesion was attributed to APS.
- Histological examination ruled out infective endocarditis as the cause of the valve lesion.
- The patient underwent successful mechanical mitral valve replacement.
Implications:
- This case underscores the potential for antiphospholipid syndrome to manifest as cardiac valve lesions that mimic infective endocarditis.
- It emphasizes the need for a comprehensive diagnostic approach, including autoimmune screening, in patients with suspected endocarditis and atypical presentations.
- Early recognition and management of APS-related cardiac involvement can prevent severe complications and guide treatment strategies.
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