Unusual Presentation of Isolated Nonbacterial Thrombotic Tricuspid Valve Endocarditis in Systemic Lupus Erythematosus With Secondary Antiphospholipid Syndrome: A Case Report

Nonbacterial thrombotic endocarditis (NBTE), or marantic endocarditis, is one of the most prevalent cardiac presentations seen in patients with systemic lupus erythematosus (SLE). It is a condition that is characterized by noninfectious lesions affecting cardiac valves. The most common sight for this disease to affect is the left-sided mitral and aortic cardiac valves. It rarely involves the right-sided tricuspid valve. However, having a secondary condition that increases risk for hypercoagulability can potentiate the severity and frequency of cardiac valvular disease in SLE. In this report, the authors describe a rare case of a patient who presented with clinically symptomatic isolated-sterile tricuspid valve vegetations likely due to antiphospholipid syndrome (APLS) on top of SLE. Optimal medical and surgical managements of these vegetations are not well defined. Criteria call for surgical intervention in infective endocarditis when there are severe heart failure or valve dysfunction, prosthetic valve infection, recurrent systemic emboli, large mobile vegetations, and other detrimental complications. However, intervention for sterile vegetations should also be discussed if the patient can benefit from it clinically and if it can improve quality of life. The authors discuss this case in the context of the relevant medical and surgical literature.