Téma:  Case Studies

Mitral valve endocarditis in a patient with systemic lupus erythematosus: infective or libman-sacks?

Juraj Dúbrava, Adriana Gurecková, Zuzana Nižňanská

We describe a case of a 29-year-old woman with systemic lupus erythematosus and antiphospholipid syndrome with an accidental finding of a mitral vegetation in 25th week of pregnancy. This case report documents the difficulty in differential diagnostics of endocarditis in patients with systemic lupus. Inflammation of the heart valves in systemic lupus erythematosus occurs either as a specific Libman-Sacks (L-S) endocarditis, nonspecific infective endocarditis or as a combination of both. Leukopenia, normal CRP level and positive antiphospholipid antibodies support the diagnosis of L-S endocarditis. Negative hemocultures, antibiotic treament failure, localisation of mitral vegetations on the ventricular surface and aortic vegetations on the vascular surface are additional supportive criteria. Possible localization of the vegetations on both sides of the leaflets in L-S endocarditis is distinct from strictly one-sided localization in infective endocarditis. Infective endocarditis lesions are more likely to be located at the leaflet’s line of closure. In contrast, Libman-Sacks vegetations can be located anywhere on the leaflets. Distinguishing infective endocarditis from L-S endocarditis is of principal importance because of radically different treatment of them.

Ročník 2009  Témy časopisu Internal medicine 4 / 2009

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