Antiphospholipid syndrome masquerading as a case of infective endocarditis

Abstract

A 54-year-old Caucasian woman presented with an episode of loss of consciousness and dysphasia. MRI revealed a number of ischaemic foci indicating an embolic source. Echocardiography showed a mitral valve vegetation. After taking three sets of blood cultures, she was started on empirical treatment for infective endocarditis. The blood cultures remained negative and a presumed diagnosis of culture-negative endocarditis was entertained. However, despite the antibiotic therapy, the patient deteriorated further. Subsequently the patient was found to be positive for antiphospholipid antibodies. Eventually, after a convoluted hospital stay, a diagnosis of antiphospholipid syndrome complicated by Libman-Sacks endocarditis was reached. The patient was treated with steroids and anticoagulation with dramatic improvement.

Recurrent nonbacterial thrombotic endocarditis and stroke on anticoagulation

“…Antiphospholipid antibodies and complement have been noted on involved valves which suggests that APS is a risk factor for NBTE [ 6 ]. It is believed that these autoantibodies are directed against the phospholipids in the endothelium and not only damage the endothelium but also mediate activation and deposition of platelet and fibrin [ 2 , 5 , 7 ]. These lesions are more friable than the vegetations seen in infective endocarditis and are more prone to systemic embolization [ 1 , 2 ].…”

“…Anticardiolipin IgG or IgM, anti-B 2 glycoprotein IgG or IgM and lupus anticoagulant associated with history of thrombosis or pregnancy morbidity are required for a diagnosis of definite APS [7,9]. Patients may also have hemolytic anemia and thrombocytopenia.…”