SCIENTIFIC JOURNAL of the Hungarian Society of Cardiology

Mitral valve vegetation with a rare etiology: Libman-Sacks endocarditis

█ Case report

DOI: 10.26430/CHUNGARICA.2018.48.1.36

Grátz Szandra1, Pelyhe János2, Alizadeh Hussain3, Sütő Gábor4, Tornóczki Tamás5, Kálmán Endre5, Szabados Sándor1, Cziráki Attila1, Faludi Réka1
1Pécsi Tudományegyetem, Klinikai Központ, Szívgyógyászati Klinika, Pécs
2Nagyatádi Kórház, Belgyógyászati Osztály, Nagyatád
3Pécsi Tudományegyetem, Klinikai Központ, I. sz. Belgyógyászati Klinika, Hematológiai Tanszék, Pécs
4Pécsi Tudományegyetem, Klinikai Központ, Reumatológiai és Immunológiai Klinika, Pécs
5Pécsi Tudományegyetem, Általános Orvostudományi Kar, Pathológiai Intézet, Pécs


A special case of heart failure is presented, caused by mitral valve vegetation. Previous medical history of the 43 years old woman includes thrombotic episodes. In the background of her dyspnea severe mitral regurgitation and a 2 cm large mass on the anterior mitral leaflet were reported with echocardiography. Her inflammatory markers were slightly elevated. Blood cultures were negative. Based on her anti-double- stranded DNA and antiphospholipid antibody positivity, SLE and secondary antiphospholipid syndrome were diagnosed. Corticosteroid and chloroquin therapy resulted in improvement of the inflammatory markers. In compensated status biological mitral valve was implanted. The mass macroscopically appeared as a vegetation but histopathological analysis revealed nonbacterial thrombotic endocarditis. The causal role of her autoimmune disease was supposed (Libman-Sacks endocarditis). Therefore, after the surgery she was anticoagulated with vitamin K antagonist. Recently, due to the continuous immunologic and cardiologic care, the patient is symptomless. Such large vegetation and severe clinical picture is rarely reported in the literature in SLE. The differentiation of this disorder from infective endocarditis may be a diagnostic problem.


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