Libman-Sachs Endocarditis Research Articles

Libman–Sachs endocarditis: regression after immunosuppressive therapy in a patient with systemic lupus erythematosus

Libman–Sachs endocarditis (nonbacterial thrombotic endocarditis, NBTE) may be one of the cardiac manifestations of systemic lupus erythematosus (SLE). It is characterized by the presence of sterile platelet thrombi on previously normal heart valves. The diagnosis of NBTE is difficult as it is often asymptomatic until complications such as systemic emboli or valvular dysfunction occur. Patients with Libman–Sachs endocarditis and SLE are treated with immunosuppressive and anticoagulant therapy and, if it is ineffective, surgical treatment.A clinical case of SLE and Libman–Sachs endocarditis is presented. The clinical manifestations, diagnostic methods and treatment of NBTE in SLE are discussed. The difficulties in differential diagnosis and selection of optimal treatment tactics faced by physicians are highlighted.

Hematological manifestations of systemic lupus erythematosus in the early stage: association with other symptoms of the disease and possible prognostic value

Objective: to assess the relationship between hematological manifestations of systemic lupus erythematosus (SLE) in the early stage of the disease and development of other syndromes and symptoms of the disease, as well as the nature and severity of internal organs damage during the subsequent five-year period.Subjects and methods. The analysis of data of examination of 89 patients with SLE during the five-year period was carried out. The frequency of clinical manifestations of SLE, the level of antinuclear and antiphospholipid antibodies, SLICC/ACR damage index (SDI) depending on the presence of hematological manifestations of SLE in the onset of the disease including leukopenia (LP), thrombocytopenia (TP) and autoimmune hemolytic anemia (AGA) were studied.Results and discussion. In the onset of SLE LP was observed in 21.3%, TP – in 26.9%, AGA – in 8.9% of patients. The presence of LP was associated with an increase of antibodies to SSA frequency, and TP – with more frequent detection of antibodies to Ro-52, cardiolipin and β-2-glycoprotein (p<0.05). Patients with TP in the onset of SLE compared with patients without hematological manifestations, had an increase (p<0.05) of the cumulative incidence of nephritis (83.3 and 42.9%), central nervous system lesions (70.8 and 26.5%), vasculitis (45.8 and 10.2%) and Libman-Sachs endocarditis (20.8 and 6.1%, respectively), which was accompanied by an increase of SDI values (median was 2.09 [2, 1.82; 2.21] and 1.12 [0.81; 1.32], p<0.05). In patients with LP, the cumulative incidence of pneumonitis and Sjogren's syndrome was increased in the onset of SLE compared with patients without hematological manifestations (15.8 vs 6.1% and 15.7 vs 2.0%, respectively, p<0.05).Conclusion. Presence of TP in the onset of SLE is a predictor of kidneys, central nervous system, peripheral vessels and heart valves damage during the next 5 years.

Dyspnoea in lupus

A 32-year-old woman suffering from systemic lupus erythematosus presented with a 6-week history of progressive dyspnoea and pleuritic chest pain. Examination was normal apart from reduced air entry at the...

English

Libman-Sacks endocarditis is the characteristic cardiac manifestation of autoimmune disease Systemic Lupus Erythematosus. The condition most commonly involves the mitral and aortic valves, but all the four cardiac valves and the endocardial surfaces can be involved 1 . Persons with Libman-Sacks endocarditis are usually asymptomatic., but become symptomatic due to cardiac failure, cerebrovascular embolism, systemic thromboembolism and secondary infective endocarditis. 2D Echocardiography should be performed when it is suspected. With introduction of steroid therapy for SLE, improved longevity of patients appears to have changed the spectrum of valvular disease. Herewith, we are reporting a 35 year old female who presented at Department of General Medicine, GGH, Guntur with seven day history of anasarca, shortness of breath, cough and fever of long duration. ECHO was suggestive of Libman-Sachs endocarditis and further investigations revealed SLE. On addition of steroids, there was good response and the patient was improving, but she had sudden cardio-respiratory arrest 5 days later.

Diagnostic Strategy for Blood Culture–Negative Endocarditis

result of empirical antibiotic treatment before blood culture sampling. 2. Zoonotic agents, especially Coxiella and Bartonella species, are important causes of BCNE and may be prevalent. In the first case, streptococci, being the most common and antibiotic-susceptible agents of infective endocarditis overall, are cleared from the bloodstream, and valve tissue, from patients undergoing surgery, may be used for diagnosis through histopathological analysis and molecular biology tools. Considering all etiologies, the molecular biology tools used provided a diagnosis for 14% of blood samples and two-thirds of the valves studied, through broad-range polymerase chain reaction (PCR) (16S ribosomal DNA and 18S ribosomal DNA PCR assays). Concerning the zoonotic agents Bartonella and Coxiella species, results of serological analysis were positive, with titers compatible with endocarditis in nearly half the patients (47.7%) in the series. Because treatment for Bartonella endocarditis should include an aminoglycoside, since this affects the outcome, and because treatment for Coxiella endocarditis is long and specific (doxycycline plus cloroquine for many months, with close serological follow-up to determine cure), it is mandatory to rule in or rule out these diagnoses as early as possible in the workup. This study also brings new messages to the field: sophisticated methods, such as primer extension enrichment reaction (PEER) identified very few additional cases, and this was also the case for autoimmunohistochemistry of valvular tissue. Also, cell culture did not provide any additional diagnoses beyond those determined by serological analysis and PCR. Therefore, these tests should be used in exceptional circumstances. Histopathological analysis remains very important, and several diagnoses that were not infective were made on the basis of such analysis, including angiosarcoma and myxoma, as well as Libman-Sachs endocarditis, marantic endocarditis, and Behcet-associated endocarditis.

Getting to the Heart of the Matter

A 21-year-old Hispanic woman presented with a history of spontaneous miscarriage developed palpable purpura and transient visual loss followed by permanent vision loss OD, secondary to a central retinal artery occlusion with concomitant optic disk edema. The differential diagnosis for vascular occlusion in systemic lupus erythematosus includes antiphospholipid antibody, systemic lupus erythematosus–related vasculitis, hypercoaguable state, or Libman-Sachs endocarditis.

Tumeur métastatique valvulaire diagnostiquée du vivant du malade

Introduction . – The discovery of an endocardial mass always raises the question of its nature. Infectious endocarditis is the most frequent cause, but others diagnoses must be considered. Exegesis . – We report a case of endocardial metastasis originating from an upper respiratory tract epidermoid carcinoma in a 48-years-old man. The diagnosis was established while the patient was alive, and survival at the time of writing is 8 months. This case report provides an opportunity for discussion of the differential diagnosis when confronted with an endocardial tumor, i.e. bacterial endocarditis, non-bacterial thrombotic endocarditis, primary cardiac tumors, metastatic osteogenic sarcoma and Libman-Sachs endocarditis. Conclusion . – Non bacterial thrombotic endocarditis and valvular metastasis should be considered upon discovery of a valvular tumor, in the context of neoplastic disease. The prognosis of endocardial metastasis is poor, but early diagnosis and appropriate management should eventually prolong survival.

Aortic allografts and pulmonary autografts for replacement of the aortic valve and aortic root

Background. Extensive experience has accumulated with the use of aortic and pulmonary autografts for replacement of the aortic valve and the aortic root. Three general techniques for insertion have been used: subcoronary (free-hand) valve implantation, mini- or inclusion-root implantation, and aortic root replacement. Thirty-day mortality for elective operations with all of these techniques has not exceeded 5%. Thromboembolic episodes have been rare, and endocarditis has occurred infrequently. Early hemodynamic performance has been excellent, without significant gradients or valve regurgitation in the majority of patients. Methods and Results. Progressive aortic regurgitation has been observed with continued follow-up, and is the most important complication of both types of valves. Leaflet failure and technical problems are the major causes of reoperation for patients receiving aortic allografts. There is some evidence to suggest that the prevalence of these complications is lower with the root replacement technique than with the intraaortic implantation methods. Conclusions. Reoperation for regurgitation of the neo-aortic valve is the major complication of the pulmonary autograft procedure. The incidence of reoperation appears to be lowest with the root replacement technique. Certain conditions (acute rheumatic fever, juvenile rheumatoid arthritis, systemic lupus, ankylosing spondylitis, Libman-Sachs endocarditis, and possibly a dilated aortic root) may be contraindications to the use of a pulmonary autograft. Reoperation on the pulmonary allograft that is used to replace the autograft may be necessary in up to 20% of patients at 20 years.

Prevalence and significance of hypertension in systemic lupus erythematosus.

SYSTEMIC lupus erythematosus (SLE) is a multisystem disease of putative autoimmune nature, which often heavily involves the cardiovascular system. Cardiac abnormalities, including systemic hypertension, are among the most severe complications of SLE, and have been reported in from 52% to 89% of cases. 1·3 Pericarditis, myocarditis, and Libman-Sachs endocarditis are the most common form of cardiac involvement. These lesions are characterized by inflammatory infiltrates in the pericardium and in the interstium of the myocardium. Coronary artery disease is recognized in a variable proportion of SLE patients (from 2% to 8% of cases).4,5 In a multicentric study involving 1,103 SLE patients,6 222 deaths were recorded and myocardial infarction was the cause of death in seven (3%). This proportion exceeded the expected value for a matched general population. These seven patients were older than the average when compared with the study population and had lupus for a longer time. Another study has shown that deaths in SLE patients were attributable to the activity of the disease in the early course and primarily to cardiovascular problems later on during the follow-up. Systemic hypertension was reported in 7% to 14% of patients in the early reports. I,4 More recently the prevalence of hypertension has ranged from 25% to 49% ofSLE patients.The reason for this apparent increase in the incidence of hypertension in unclear: the survival to an older age and the intensive use of corticosteroids may be involved.

Atteinte cardiaque au cours du syndrome primaire des anticorps antiphospholipides : 6 observations

Antiphospholipid antibodies are well recognized to be associated with cardiac disease in patients with systemic lupus erythematosus. The authors report valvular lesions (similar to Libman-Sachs endocarditis, mitral and aortic regurgitation with verrucous thickning) in four out of six patients with primary antiphospholipid syndrome.

Cross-sectional echocardiography in the diagnosis of Libman-Sachs endocarditis

A case is presented where the distinction between rheumatic fever and systemic lupus as a cause of mitral valvar disease was made by cross-sectional echocardiography. This showed an unusual appearance, consistent with descriptions of Libman-Sachs endocarditis from the presteroid era.