Asian Journal of Cardiology Research

Systemic Lupus Erythematosus revealed by Libman-Sacks Endocarditis: A Case Report

Asmaa Elamraoui *

Cardiology Department, CHU Ibn Rochd, N°1 quartier des Hopitaux-24200, Casablanca, Morocco.

Adam Fadoul

Cardiology Department, CHU Ibn Rochd, N°1 quartier des Hopitaux-24200, Casablanca, Morocco.

Yousra Hamine

Cardiology Department, CHU Ibn Rochd, N°1 quartier des Hopitaux-24200, Casablanca, Morocco.

Ghali Bennouna

Cardiology Department, CHU Ibn Rochd, N°1 quartier des Hopitaux-24200, Casablanca, Morocco.

Leila Azzouzi

Cardiology Department, CHU Ibn Rochd, N°1 quartier des Hopitaux-24200, Casablanca, Morocco.

Abdenasser Drighil

Cardiology Department, CHU Ibn Rochd, N°1 quartier des Hopitaux-24200, Casablanca, Morocco.

Rachida Habbal

Cardiology Department, CHU Ibn Rochd, N°1 quartier des Hopitaux-24200, Casablanca, Morocco.

*Author to whom correspondence should be addressed.

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Abstract

Libman-Sacks endocarditis (LSE) is a rare cardiovascular manifestation of systemic lupus erythematosus and has been described as an aseptic verrucous non-bacterial autonomic disease. Theselesions can cause progressive damage to heart valves and may need surgery. The aortic and mitral valves are the most commonly affected valves. The majority of LSE patients are usually asymptomatic. Case overview, we describe a 29-year-old women patient who presented with dyspnea, increased pulmonary congestion and severe mitral regurgitation with vegetation revealed by transthoracic echocardiography and was diagnosed as Libman-Sacks endocarditis after laboratary test including blood cultures, autoimmune profile, and testing for hypercoagulability.

Keywords: Libman-sacks endocarditis, systemic lupus erythematous, hypercoagulability

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References

Bourré-Tessier J, Huynh T, Clarke AE, Bernatsky S, Joseph L, Belisle P, Pineau CA. Features associated with cardiac abnormalities in systemic lupus erythematosus. Lupus. 2011;20(14):1518–1525. DOI: 10.1177/0961203311420318

Ginanjar E, Yulianto Y. Autoimmune disease with cardiac valves involvement: Libman-sacks endocarditis. Acta Med Indones. 2017;49(2):148-150.

Ferreira E, Bettencourt PM, Moura LM. Valvular lesions in patients with systemic lupus erythematosus and antiphospholipid syndrome: An old disease but a persistent challenge. Revista Portuguesa de Cardiologia. 2012;31(4):295–299. DOI:10.1016/j.repc.2012.02.005

Yamashita G, Kanemitsu N, Nakashima Y, Matsuo T, Nakane T, Honda M, Okabayashi H. Hypertrophic obstructive cardiomyopathy and mitral regurgitation in Libman-Sacks endocarditis. Gen Thorac Cardiovasc Surg. 2020;68(2):181-184.

Akhlaq A, Ali TA, Fatimi SH. Mitral valve replacement in systemic lupus erythematosus associated Libman- Sacks endocarditis. Journal of the Saudi Heart Association. 2016;28(2):124–126. DOI:10.1016/j.jsha.2015.09.003

Ibrahim AM, Siddique MS. Stat Pearls. Treasure Island FL: Stat Pearls Publishing. Libman Sacks endocarditis; 2020.

Ferreira E, Bettencourt PM, Moura LM. Valvular lesions in patients with systemic lupus erythematosus and antiphospholipid syndrome: An old disease but a persistent challenge. Revista Portuguesa de Cardiologia. 2012;31(4):295–299. DOI: 10.1016/j.repc.2012.02.005.

Roldan CA, Tolstrup K, Macias L, Qualls CR, Maynard D, Charlton G, Sibbitt WL Jr .Libman-Sacks endocarditis: detection, characterization, and clinical correlates by three-dimensional transesophageal echo-cardiography.. J Am Soc Echocardiogr. 2015;28:770–779

Yoo BW, Lee SW, Song JJ, Park YB, Jung SM. Clinicalcharacteristics and long-term out comes of Libman-Sacks endocarditis in patients with systemic lupus erythematosus. Lupus. 2020;29(9):1115-1120.

Chen S, Smith B, Ilina M, Bowen C, Martin N. PReS-FINAL-2307: Libman-Sacks endocarditis as a presentation for systemic lupus erythematous in an adolescent with isolated mitrial regurgitation and Noonan syndrome. Pediatric Rheumatology. 2013;11(Supplement2) DOI: 10.1186/1546-0096-11-s2-p297

Gorki H, Malinovski V, Stanbridge RDL. The antiphospholipid syndrome and heart valve surgery. European Journal of Cardio-Thoracic Surgery. 2008;33(2): 168–181. DOI: 10.1016/j.ejcts.2007.11.004

Akhlaq A, Ali TA, Fatimi SH. Mitral valve replacement in systemic lupus erythematosus associated Libman- Sacks endocarditis. Journal of the Saudi Heart Association. 2016;28(2):124–126. DOI: 10.1016/j.jsha.2015.09.003

Vassileva CM, Swong MN, Boley TM, Markwell SJ, Hazelrigg SR. Influence of systemic lupus erythematosus on procedure selection and outcomes of patients undergoing isolated mitral valve surgery. Journal of Cardiac Surgery. 2012; 27(1):29–33. DOI: 10.1111/j.1540-8191.2011.01393.x