Libman-Sacks endocarditis consists of aseptic valvular abnormalities, associated with systemic lupus erythematosus and antiphospholipid syndrome. Embolic ischaemic stroke is a possible clinical presentation. The authors present the case of a woman in her fourth decade who developed central facial palsy after several transient ischaemic attacks with visual loss. Cerebral imaging revealed multiple small ischaemic lesions in the right hemisphere. The transoesophagic echocardiogram showed mitral vegetations and she tested positive for antiphospholipid antibodies. She underwent mitral valve replacement for a mechanical prosthesis due to extensive valvular damage and started anticoagulation. The valve's microbiological exams were negative establishing the diagnosis of libman-sacks endocarditis. Endocarditis should be suspected with sequential cerebral ischaemia in patients of all ages. Valvular surgery is the mainstay of treatment in recurrent embolic events. Association with antiphospholipid antibodies is common yet a poor-known fact. The patient is currently asymptomatic on warfarin and aspirin, with a normal functioning mitral prosthesis.
An association between macrovascular thrombosis and idiopathic inflammatory bowel disease has been described, although very few well-documented cases have been published. We report on a 39-year-old woman who presented with right hemifacial and upper limb edema that was shown to be due to an extensive right brachiocephalic vein thrombosis, diagnosed by magnetic resonance angiography. Laboratory findings suggested malabsorption, and a diagnosis of Crohn's disease was established. Moreover, elevation of the plasminogen activator inhibitor system was identified. This represents the first description of a spontaneous thrombosis in a patient with Crohn's disease involving the intrathoracic venous system and raises the possibility of impaired fibrinolysis being involved in the etiopathogenesis of this complication.
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