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Multiple embolic strokes as a result of Libman–Sacks endocarditis associated with lupus and secondary antiphospholipid antibody syndrome: a case report
BACKGROUND: Libman–Sacks endocarditis (LSE) is an infrequently recognized pathogenesis of embolic cerebrovascular disease. Patients often have asymptomatic valvular dysfunction which if not recognized promptly, can lead to serious complications such as heart failure, arrhythmias, cerebroembolic phen...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6176972/ https://www.ncbi.nlm.nih.gov/pubmed/31020171 http://dx.doi.org/10.1093/ehjcr/yty094 |
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author | Arnautovic, Jelena Z Yamasaki, Hiroshi Rosman, Howard S |
author_facet | Arnautovic, Jelena Z Yamasaki, Hiroshi Rosman, Howard S |
author_sort | Arnautovic, Jelena Z |
collection | PubMed |
description | BACKGROUND: Libman–Sacks endocarditis (LSE) is an infrequently recognized pathogenesis of embolic cerebrovascular disease. Patients often have asymptomatic valvular dysfunction which if not recognized promptly, can lead to serious complications such as heart failure, arrhythmias, cerebroembolic phenomena with increased neurocognitive disability, and even death. It can be associated with systemic lupus erythematosus and/or antiphospholipid antibody syndrome (APLS). CASE SUMMARY: Previously very healthy and active, 49-year-old Caucasian female with past medical history of mild lupus, for which she stopped treatment 10 year ago, saw a primary care physician complaining of intermittent double vision of 2 months duration. Urgent brain magnetic resonance imaging revealed multiple embolic infarcts of the brain stem. Further comprehensive work-up led to diagnosis of mitral LSE and APLS. After 2 months of systemic anticoagulation with warfarin and immunosuppressive therapy with hydroxychloroquine sulfate, repeat imaging demonstrated resolution of the mitral valve vegetation with no clinical recurrence of thromboembolic events at 6 months. DISCUSSION: Mild, often silent, autoimmune disease as described in our case can lead to significant cerebrovascular disease. Patients who present with cryptogenic strokes with high suspicion of underlying autoimmune disease should be worked up thoroughly for possible valvular heart disease associated with lupus, APLS, or both. Acquisition of transoesophageal images proved superior to transthoracic approach and it should be implemented in these subsets of patients. With this case report, we highlight the importance of early recognition of cardiac manifestations, amelioration of risk factors, as well as close follow-up of lupus or APLS patients, as crucial steps in reducing their morbidity and mortality along with preventing recurrence or progression of cerebrovascular disease. |
format | Online Article Text |
id | pubmed-6176972 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-61769722019-04-24 Multiple embolic strokes as a result of Libman–Sacks endocarditis associated with lupus and secondary antiphospholipid antibody syndrome: a case report Arnautovic, Jelena Z Yamasaki, Hiroshi Rosman, Howard S Eur Heart J Case Rep Case Reports BACKGROUND: Libman–Sacks endocarditis (LSE) is an infrequently recognized pathogenesis of embolic cerebrovascular disease. Patients often have asymptomatic valvular dysfunction which if not recognized promptly, can lead to serious complications such as heart failure, arrhythmias, cerebroembolic phenomena with increased neurocognitive disability, and even death. It can be associated with systemic lupus erythematosus and/or antiphospholipid antibody syndrome (APLS). CASE SUMMARY: Previously very healthy and active, 49-year-old Caucasian female with past medical history of mild lupus, for which she stopped treatment 10 year ago, saw a primary care physician complaining of intermittent double vision of 2 months duration. Urgent brain magnetic resonance imaging revealed multiple embolic infarcts of the brain stem. Further comprehensive work-up led to diagnosis of mitral LSE and APLS. After 2 months of systemic anticoagulation with warfarin and immunosuppressive therapy with hydroxychloroquine sulfate, repeat imaging demonstrated resolution of the mitral valve vegetation with no clinical recurrence of thromboembolic events at 6 months. DISCUSSION: Mild, often silent, autoimmune disease as described in our case can lead to significant cerebrovascular disease. Patients who present with cryptogenic strokes with high suspicion of underlying autoimmune disease should be worked up thoroughly for possible valvular heart disease associated with lupus, APLS, or both. Acquisition of transoesophageal images proved superior to transthoracic approach and it should be implemented in these subsets of patients. With this case report, we highlight the importance of early recognition of cardiac manifestations, amelioration of risk factors, as well as close follow-up of lupus or APLS patients, as crucial steps in reducing their morbidity and mortality along with preventing recurrence or progression of cerebrovascular disease. Oxford University Press 2018-08-17 /pmc/articles/PMC6176972/ /pubmed/31020171 http://dx.doi.org/10.1093/ehjcr/yty094 Text en © The Author(s) 2018. Published by Oxford University Press on behalf of the European Society of Cardiology. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Case Reports Arnautovic, Jelena Z Yamasaki, Hiroshi Rosman, Howard S Multiple embolic strokes as a result of Libman–Sacks endocarditis associated with lupus and secondary antiphospholipid antibody syndrome: a case report |
title | Multiple embolic strokes as a result of Libman–Sacks endocarditis associated with lupus and secondary antiphospholipid antibody syndrome: a case report |
title_full | Multiple embolic strokes as a result of Libman–Sacks endocarditis associated with lupus and secondary antiphospholipid antibody syndrome: a case report |
title_fullStr | Multiple embolic strokes as a result of Libman–Sacks endocarditis associated with lupus and secondary antiphospholipid antibody syndrome: a case report |
title_full_unstemmed | Multiple embolic strokes as a result of Libman–Sacks endocarditis associated with lupus and secondary antiphospholipid antibody syndrome: a case report |
title_short | Multiple embolic strokes as a result of Libman–Sacks endocarditis associated with lupus and secondary antiphospholipid antibody syndrome: a case report |
title_sort | multiple embolic strokes as a result of libman–sacks endocarditis associated with lupus and secondary antiphospholipid antibody syndrome: a case report |
topic | Case Reports |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6176972/ https://www.ncbi.nlm.nih.gov/pubmed/31020171 http://dx.doi.org/10.1093/ehjcr/yty094 |
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