Noninfective Endocarditis in a Young Patient with Systemic Lupus Erythematosus

CASE REPORT
Daniela Teferiçi, Arjan Shtylla, Alma Idrizi, Aldo Shpuza, Enver Roshi, Alban Dibra

 
For citation: Teferiçi D, Shtylla A, Idrizi A, Shpuza A, Roshi E, Dibra A. Noninfective Endocarditis in a Young Patient with Systemic Lupus Erythematosus. International Journal of Biomedicine. 2024;14(2):338-340. doi:10.21103/Article14(2)_CR1
 
Originally published June 5, 2024
 

Abstract: 

Noninfective endocarditis, particularly in association with systemic autoimmune diseases like systemic lupus erythematosus (SLE), presents a diagnostic challenge due to its nonspecific symptoms and the potential for severe cardiac complications. We describe a case of a 16-year-old female diagnosed with SLE who presented with fever, malaise, and a new heart murmur. Subsequent investigations revealed vegetations on the mitral valve consistent with noninfective endocarditis without any evidence of infectious etiology. This case underscores the importance of considering noninfective endocarditis in the differential diagnosis for patients with systemic autoimmune disorders presenting with fever and cardiac symptoms. Early recognition and management are crucial to prevent serious outcomes.

Keywords: 
systemic lupus erythematosus • noninfective endocarditis • Libman-Sacks endocarditis
References: 
  1. LIBMAN E, SACKS B. A HITHERTO UNDESCRIBED FORM OF VALVULAR AND MURAL ENDOCARDITIS. Arch Intern Med (Chic). 1924;33(6):701–737. doi:10.1001/archinte.1924.00110300044002
  2. Ruiz-Irastorza, G. Khamashta M.  Cardiopulmonary system in SLE. Dubois’ Lupus Erythematosus and Related Syndromes.Wallace DJ et al., Eds. 8th ed.  Elsevier, 2012: 352-362.
  3. Moyssakis I, Tektonidou MG, Vasilliou VA, Samarkos M, Votteas V, et al. (2007) Moyssakis I, Tektonidou MG, Vasilliou VA, Samarkos M, Votteas V, Moutsopoulos HM. Libman-Sacks endocarditis in systemic lupus erythematosus: prevalence, associations, and evolution. Am J Med. 2007 Jul;120(7):636-42. doi: 10.1016/j.amjmed.2007.01.024. PMID: 17602939.
  4. Hojnik M, et al. Hojnik M, George J, Ziporen L, Shoenfeld Y. Heart valve involvement (Libman-Sacks endocarditis) in the antiphospholipid syndrome. Circulation. 1996 Apr 15;93(8):1579-87. doi: 10.1161/01.cir.93.8.1579. PMID: 8608627.
  5. Barnes EV, Narain S, Naranjo A, Shuster J, Segal MS, Sobel ES, Armstrong AE, Santiago BE, Reeves WH, Richards HB. High sensitivity C-reactive protein in systemic lupus erythematosus: relation to disease activity, clinical presentation and implications for cardiovascular risk. Lupus. 2005;14(8):576-82. doi: 10.1191/0961203305lu2157oa. PMID: 16175928.
  6. Crozier IG, Li E, Milne MJ, Nicholls MG. Cardiac involvement in systemic lupus erythematosus detected by echocardiography. Am J Cardiol. 1990 May 1;65(16):1145-8. doi: 10.1016/0002-9149(90)90329-y. PMID: 2330902.
  7. Fujimoto S, Kagoshima T, Nakajima T, Dohi K. Doppler echocardiographic assessment of left ventricular diastolic function in patients with systemic lupus erythematosus. Cardiology. 1994;85(3-4):267-72. doi: 10.1159/000176685. PMID: 7987885.
  8. Manzi S, Meilahn EN, Rairie JE, Conte CG, Medsger TA Jr, Jansen-McWilliams L, D'Agostino RB, Kuller LH. Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with the Framingham Study. Am J Epidemiol. 1997 Mar 1;145(5):408-15. doi: 10.1093/oxfordjournals.aje.a009122. PMID: 9048514.
  9. Roman MJ, Shanker BA, Davis A, Lockshin MD, Sammaritano L, Simantov R, Crow MK, Schwartz JE, Paget SA, Devereux RB, Salmon JE. Prevalence and correlates of accelerated atherosclerosis in systemic lupus erythematosus. N Engl J Med. 2003 Dec 18;349(25):2399-406. doi: 10.1056/NEJMoa035471. Erratum in: N Engl J Med. 2006 Oct 19;355(16):1746. PMID: 14681505.

Download Article
Received February 23, 2024.
Accepted March 31, 2024.
©2024 International Medical Research and Development Corporation.