Endocardite por Streptococcus gallolyticus em portadora de lúpus eritematoso sistêmico: avaliação pelo ecocardiograma tridimensional

Abstract

A 42 year-old woman was referred to our hospital with a history of fever and poor general status for the last 30 days. She presented tachycardia and a systolic apical murmur. Laboratory tests revealed leukocytosis of 13,100/mL, hemoglobin of 8.4g/dL and positive systemic lupus erythematosus antibodies (anti-Ro/SSA, anti-La/SSB, anticardiolipin, and antinuclear antibodies); blood culture was positive for Streptococcus gallolyticus. Three-dimensional transesophageal echocardiography was performed and revealed multiple mitral valve vegetations, with leaflet perforation and important mitral regurgitation, as well as large aortic vegetation, with cusp perforation and severe regurgitation. Additionally, a small vegetation was observed on the tricuspid valve, which presented moderate regurgitation. Three-dimensional transesophageal echocardiography provides appropriate visualization of complications resulting from infectious endocarditis.

Risk of infective endocarditis in patients with systemic lupus erythematosus in Taiwan: a nationwide population-based study

“…There exist case reports of SLE patients with IE caused by various rare pathogens. 6–12 Valvular damage caused by Libman–Sacks endocarditis has been suggested to predispose SLE patients to IE after invasive procedure-related transient bacteremia. Zysset et al.…”

“…The disordered immune system of lupus patients plus the long-term use of immunosuppressants lead to infection being a crucial morbidity and cause of mortality in SLE patients. 4,5 Some case reports have correlated IE with SLE, 6–12 but no study revealed the incidence rate and higher prevalence of IE in an SLE cohort. 13 Libman–Sacks lesions are common in SLE patients, although often subclinical.…”