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A Rare Case of Tricuspid Valve Libman–Sacks Endocarditis in a Pregnant Woman with Primary Antiphospholipid Syndrome

Antiphospholipid Antibody Syndrome (APS) is a systemic autoimmune disease characterized by acquired hypercoagulability with the possible development of venous, arterial, and microvascular thrombosis. We report a rare case of Libman–Sacks tricuspid valve endocarditis in a 38-year-old pregnant woman a...

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Autores principales: Migliorini, Sonia, Santoro, Ciro, Scatteia, Alessandra, Dellegrottaglie, Santo, Tufano, Antonella, Cuomo, Vittoria, Pilato, Emanuele, Comentale, Giuseppe, D’Armiento, Maria, Guida, Maurizio, Sarno, Laura
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9573308/
https://www.ncbi.nlm.nih.gov/pubmed/36233742
http://dx.doi.org/10.3390/jcm11195875
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author Migliorini, Sonia
Santoro, Ciro
Scatteia, Alessandra
Dellegrottaglie, Santo
Tufano, Antonella
Cuomo, Vittoria
Pilato, Emanuele
Comentale, Giuseppe
D’Armiento, Maria
Guida, Maurizio
Sarno, Laura
author_facet Migliorini, Sonia
Santoro, Ciro
Scatteia, Alessandra
Dellegrottaglie, Santo
Tufano, Antonella
Cuomo, Vittoria
Pilato, Emanuele
Comentale, Giuseppe
D’Armiento, Maria
Guida, Maurizio
Sarno, Laura
author_sort Migliorini, Sonia
collection PubMed
description Antiphospholipid Antibody Syndrome (APS) is a systemic autoimmune disease characterized by acquired hypercoagulability with the possible development of venous, arterial, and microvascular thrombosis. We report a rare case of Libman–Sacks tricuspid valve endocarditis in a 38-year-old pregnant woman at 15 weeks gestation with unknown primary antiphospholipid syndrome. During a routine cardiac examination and echocardiography performed for a previous episode of pleuropericarditis, a large, mobile mass with irregular edges was found at the level of the tricuspid valve. Three main differential diagnoses for intramyocardial mass were examined: tumor, infective endocarditis, and nonbacterial thrombotic endocarditis (NTBE). Cardiac magnetic resonance imaging (CMR) with contrast raised the suspicion of a thrombus. The woman was hospitalized urgently at the Cardiac Intensive Care Unit of the Federico II University Hospital, and anticoagulant and antiplatelet therapy were started. The thrombophilic screening performed and medical history confirmed the diagnosis of primary antibody syndrome (APS). A multidisciplinary consultation with obstetricians, cardiologists, anesthetists, and cardiac surgeons was required. The patient decided not to terminate the pregnancy despite the risk to her health and to undergo cardiac surgery during pregnancy. Histological examination confirmed the presence of nonbacterial thrombotic endocarditis. Weekly obstetric scans were performed after surgery to verify fetal well-being. An emergency cesarean section was performed at the 35th week of gestation due to repeated deceleration and abnormal short-term variability on c-CTG in a pregnancy complicated by fetal growth restriction and gestational hypertension. A newborn weighing 1290 g was born. She was hospitalized in Neonatal Intensive Care and discharged after two months; currently, she enjoys good health. The management of patients with antiphospholipid antibody syndrome has not yet been standardized, but there is a general consensus that patients who do not have thrombocytopenia, thromboembolic phenomena, or pregnancy should not undergo any treatment or should take only low doses of acetylsalicylic acid. In the presence of any of the above conditions, various treatment regimens have been used based on the severity and individuality of the case.
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spelling pubmed-95733082022-10-17 A Rare Case of Tricuspid Valve Libman–Sacks Endocarditis in a Pregnant Woman with Primary Antiphospholipid Syndrome Migliorini, Sonia Santoro, Ciro Scatteia, Alessandra Dellegrottaglie, Santo Tufano, Antonella Cuomo, Vittoria Pilato, Emanuele Comentale, Giuseppe D’Armiento, Maria Guida, Maurizio Sarno, Laura J Clin Med Case Report Antiphospholipid Antibody Syndrome (APS) is a systemic autoimmune disease characterized by acquired hypercoagulability with the possible development of venous, arterial, and microvascular thrombosis. We report a rare case of Libman–Sacks tricuspid valve endocarditis in a 38-year-old pregnant woman at 15 weeks gestation with unknown primary antiphospholipid syndrome. During a routine cardiac examination and echocardiography performed for a previous episode of pleuropericarditis, a large, mobile mass with irregular edges was found at the level of the tricuspid valve. Three main differential diagnoses for intramyocardial mass were examined: tumor, infective endocarditis, and nonbacterial thrombotic endocarditis (NTBE). Cardiac magnetic resonance imaging (CMR) with contrast raised the suspicion of a thrombus. The woman was hospitalized urgently at the Cardiac Intensive Care Unit of the Federico II University Hospital, and anticoagulant and antiplatelet therapy were started. The thrombophilic screening performed and medical history confirmed the diagnosis of primary antibody syndrome (APS). A multidisciplinary consultation with obstetricians, cardiologists, anesthetists, and cardiac surgeons was required. The patient decided not to terminate the pregnancy despite the risk to her health and to undergo cardiac surgery during pregnancy. Histological examination confirmed the presence of nonbacterial thrombotic endocarditis. Weekly obstetric scans were performed after surgery to verify fetal well-being. An emergency cesarean section was performed at the 35th week of gestation due to repeated deceleration and abnormal short-term variability on c-CTG in a pregnancy complicated by fetal growth restriction and gestational hypertension. A newborn weighing 1290 g was born. She was hospitalized in Neonatal Intensive Care and discharged after two months; currently, she enjoys good health. The management of patients with antiphospholipid antibody syndrome has not yet been standardized, but there is a general consensus that patients who do not have thrombocytopenia, thromboembolic phenomena, or pregnancy should not undergo any treatment or should take only low doses of acetylsalicylic acid. In the presence of any of the above conditions, various treatment regimens have been used based on the severity and individuality of the case. MDPI 2022-10-05 /pmc/articles/PMC9573308/ /pubmed/36233742 http://dx.doi.org/10.3390/jcm11195875 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Migliorini, Sonia
Santoro, Ciro
Scatteia, Alessandra
Dellegrottaglie, Santo
Tufano, Antonella
Cuomo, Vittoria
Pilato, Emanuele
Comentale, Giuseppe
D’Armiento, Maria
Guida, Maurizio
Sarno, Laura
A Rare Case of Tricuspid Valve Libman–Sacks Endocarditis in a Pregnant Woman with Primary Antiphospholipid Syndrome
title A Rare Case of Tricuspid Valve Libman–Sacks Endocarditis in a Pregnant Woman with Primary Antiphospholipid Syndrome
title_full A Rare Case of Tricuspid Valve Libman–Sacks Endocarditis in a Pregnant Woman with Primary Antiphospholipid Syndrome
title_fullStr A Rare Case of Tricuspid Valve Libman–Sacks Endocarditis in a Pregnant Woman with Primary Antiphospholipid Syndrome
title_full_unstemmed A Rare Case of Tricuspid Valve Libman–Sacks Endocarditis in a Pregnant Woman with Primary Antiphospholipid Syndrome
title_short A Rare Case of Tricuspid Valve Libman–Sacks Endocarditis in a Pregnant Woman with Primary Antiphospholipid Syndrome
title_sort rare case of tricuspid valve libman–sacks endocarditis in a pregnant woman with primary antiphospholipid syndrome
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9573308/
https://www.ncbi.nlm.nih.gov/pubmed/36233742
http://dx.doi.org/10.3390/jcm11195875
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