Multiple transient ischemic attacks, lupus anticoagulant and verrucous endocarditis

Area of Science:

• Neurology
• Rheumatology
• Cardiology

Background:

• Systemic lupus erythematosus (SLE) is an autoimmune disease associated with an increased risk of thrombotic events.
• Lupus anticoagulant is a specific antiphospholipid antibody linked to heightened clotting risk.
• Previous major ischemic stroke can increase susceptibility to subsequent cerebrovascular events.

Observation:

• A young adult diagnosed with lupus anticoagulant and SLE presented with recurrent, stereotyped transient ischemic attacks (TIAs).
• These TIAs occurred multiple times daily for three years, commencing four years post-major left hemispheric infarct.
• The patient's symptoms ceased following the addition of aspirin to her existing steroid treatment regimen.

Findings:

• The clinical presentation suggests recurrent embolic events originating from the heart.
• The patient's underlying thrombotic state, exacerbated by SLE and lupus anticoagulant, likely contributed to TIAs.
• The cessation of TIAs upon aspirin initiation indicates the efficacy of antiplatelet therapy in this context.

Implications:

• This case highlights the importance of considering thrombotic etiologies in young adults with SLE experiencing recurrent TIAs.
• Aggressive anticoagulation or antiplatelet strategies may be crucial for preventing further embolic events in such patients.
• Further research is warranted to elucidate the precise mechanisms linking SLE, antiphospholipid antibodies, and cardiac embolism leading to TIAs.