A case of tricuspid valve non-bacterial thrombotic endocarditis presenting as pulmonary embolism in a patient with antiphospholipid antibody syndrome

Abstract

A 47-year-old woman with a medical history of Raynaud's phenomenon presented with fever, cough and shortness of breath. She was found to have left lower lobe consolidation and pleural effusion and was treated as a case of pneumonia. During the hospital course, her respiratory status worsened, and she was intubated on the third hospital day. To investigate the high A-a gradient, a Computerized Tomographic Pulmonary Embolism (CTPE) study was done which identified a large left lower pulmonary artery embolism. She was also found to have a new murmur, and an echocardiogram demonstrated a large lesion on tricuspid valve. However, multiple sets of her blood cultures came back consistently negative. Alternative diagnoses for culture-negative endocarditis were considered, and a full set of rheumatological workup was done. Laboratory tests were suggestive of antiphospholipid syndrome, hence the diagnosis of tricuspid valve Libman-Sacks endocarditis was made.

Embolic myocardial infarction with cardiac arrest as an initial manifestation of non-bacterial thrombotic endocarditis

“…NBTE may be considered in patients with cryptogenic strokes without other determined risk factors for cerebrovascular disease 8 9. Other embolic events associated with NBTE include pulmonary embolisms and retinal artery occlusion 10 11. Diffuse alveolar haemorrhage is a rare but critical non-thrombotic manifestation of antiphospholipid syndrome or could occur from SLE capillaritis, as seen in our patient 12…”

A Rare Case of Tricuspid Valve Libman–Sacks Endocarditis in a Pregnant Woman with Primary Antiphospholipid Syndrome

“…Vegetations are mostly left-sided, with the mitral valve more frequently involved than the aortic valve [ 16 ]. Isolated tricuspid valve Libman–Sacks endocarditis is quite rare [ 16 , 17 , 18 , 19 , 20 , 21 , 22 ], thus the surgical treatment of this condition is anecdotal, especially in the absence of concomitant significant valve impairment [ 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. This is likely because the Libman–Sacks vegetations are generally small (<0.5 cm) and therefore do not require surgical excision.…”

Trivalvular nonbacterial thrombotic endocarditis in a patient with colon adenocarcinoma: a case report

“…Most clinicians base the diagnosis of NBTE on the observation of valvular vegetation in the absence of imaging evidence of inflammatory damage of the heart valves or any evidence supporting a systemic infection in patients at high risk for NBTE [ 4 , 5 ]. NBTE usually affects the left-sided valves; however, only a minority of cases involving the tricuspid valve have been reported in medical literature [ 6 ]. The current report describes trivalvular involvement by NBTE in a patient with metastatic colon adenocarcinoma.…”