Bacterial endocarditis complicating systemic lupus erythematosus

Area of Science:

• Rheumatology
• Infectious Diseases
• Cardiology

Background:

• Systemic lupus erythematosus (SLE) is an autoimmune disease affecting multiple organs.
• Bacterial endocarditis is a serious infection of the heart valves.
• The frequency of bacterial endocarditis in SLE patients is not well-established.

Purpose of the Study:

• To determine the frequency of bacterial endocarditis in patients with SLE.
• To compare the frequency of bacterial endocarditis in SLE patients to other connective tissue disease patients.

Main Methods:

• Retrospective review of patients admitted to the National Institutes of Health (NIH).
• Analysis of medical records for diagnosis of bacterial endocarditis and SLE.
• Echocardiography was performed on a subset of SLE patients.

Main Results:

• Six out of 571 SLE patients developed culture-proven bacterial endocarditis.
• Only one patient had a pre-existing valvular abnormality.
• Bacterial endocarditis occurred in 2 patients following dental procedures; no precipitating event was identified in the other 4.
• Echocardiography did not reveal previously unrecognized cardiac disease in 20 SLE patients.
• The frequency of bacterial endocarditis was unexpectedly high in SLE patients compared to other connective tissue disease patients.

Conclusions:

• Patients with SLE have a higher risk of developing bacterial endocarditis.
• Cardiac evaluation in SLE patients should consider the risk of bacterial endocarditis, even in the absence of known valvular disease.
• Further research is needed to understand the mechanisms underlying this increased risk.