Dynamic morphological changes in Libman-Sacks endocarditis under different anticoagulation regimens

Kitano, Takaya; Sengoku, Kaoruko; Itotagawa, Eri; Todo, Kenichi

doi:10.1136/bcr-2019-229909

Cited by 4 publications

(3 citation statements)

References 5 publications

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“…7 There is no clear role regarding administration of glucocorticoid and/or cytotoxic therapy for valvular lesions, due to scarcity of clinical evidence. 8,9 Some valvular abnormalities respond to anticoagulation therapy. Anticoagulation therapy is similar in patients without valvular lesions in the presence of APLS.…”

Section: Discussionmentioning

confidence: 99%

Young Stroke Following Libman-Sacks Endocarditis associated with Systemic Lupus Erythematosus and Secondary Antiphospholipid Antibody Syndrome

Amarasingha

2022

J. Ruhunu Clin. Soc.

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Libman-Sacks Endocarditis (LSE) is a form of nonbacterial thrombotic endocarditis (NBTE) occurring in the setting of hypercoagulable states like solid organ malignancies, systemic lupus erythematosus (SLE) and primary or secondary antiphospholipid antibody syndrome (APLS).LSE is the most characteristic cardiac manifestation of SLE. Even though the incidence of clinically significant valve dysfunction and embolic phenomenon is low when it is associated with secondary APLS, risk for embolic cerebrovascular events is high. We present a case of a 39-year-old female who admitted with a left sided ischemic stroke ultimately turned out to be having LSE secondary to SLE and APLS. This will demonstrate the importance of having a high degree of suspicion for the diagnosis of LSE and its etiology when evaluating a young patient with stroke.

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Section: Discussionmentioning

confidence: 99%

Young Stroke Following Libman-Sacks Endocarditis associated with Systemic Lupus Erythematosus and Secondary Antiphospholipid Antibody Syndrome

Amarasingha

2022

J. Ruhunu Clin. Soc.

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“…Unfortunately no clinical trials, as the best if our knowledge, exist regarding use of anticoagulation therapy in IE. Kitano et al presented a 51-year-old female patient with lupus who had Libman-Sacks endocarditis [17]. The patient was treated with apixaban apart from the treatment of his underlying disease, but it was switched to heparin because it had no effect on the clearance of aortic valve vegetation.…”

Section: Discussionmentioning

confidence: 99%

Culture-negative endocarditis with neurologic presentations and dramatic response to heparin: a case report

et al. 2020

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Background Blood culture-negative endocarditis (BCNE) is diagnosed in 2–7% of patients with infective endocarditis (IE) and recent antibiotic use is a known risk factor. Altered mental status may be a presenting symptom. Besides empiric antibiotics, intravenous anticoagulation using heparin may have a role in the management of such patients. Case presentation A 23-year-old male patient was referred to our center with fever, altered mental status and abnormal gait. Neurologic examination revealed Wernicke’s aphasia. Cardiac auscultation revealed systolic murmur at the left sternal border. ECG (electrocardiogram) was unremarkable. Brain MRI showed multiple cerebellar lesions. Transthoracic echocardiography (TTE) demonstrated three large masses on the right ventricle (RV), tricuspid valve (TV), and anterior mitral valve (MV) leaflet. Blood cultures (three sets) were negative. Intravenous heparin therapy was administered. After 48 h, the second TTE demonstrated that one valvular lesion disappeared and the other two lesions showed a significant decrease in size. The patient’s neurological symptoms resolved gradually. Further workup for collagen vascular disorders did not show any abnormality. Conclusion BCNE should be considered in patients with fever and neurologic manifestations. TTE should be performed to detect valvular abnormalities. Intravenous heparin could be used in such patients when TTE demonstrate valvular vegetations.

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“…Stroke is a heterogeneous disease that includes several underlying mechanisms. Because patients with SLE develop various types of stroke (12)(13)(14)(15)(16), the pathophysiology of stroke is not likely to be uniform in patients with SLE, although there is limited information regarding this heterogeneity. We hypothesized that the contribution of SLE to stroke, which is clinically important in determining the optimal treatment (1,17), may vary according to stroke subtype.…”

Section: Introductionmentioning

confidence: 99%

Heterogeneity of Stroke in Patients with Systemic Lupus Erythematosus

et al. 2022

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Objective The underlying pathophysiology varies according to stroke subtype. However, stroke heterogeneity among patients with systemic lupus erythematosus (SLE) remains unstudied. We hypothesized that the contribution of SLE to stroke might vary according to its subtype and investigated the associations of SLE and various stroke subtypes. Methods Diagnostic codes and electronic medical records were used to identify 70 patients with SLE who developed acute cerebral infarction or intracerebral hemorrhaging at four tertiary referral hospitals between 2008 and 2018. Intracerebral hemorrhaging was classified as lobar or deep, while cerebral infarction was classified according to the SSS-TOAST criteria. Physician notes were used to identify SLE activity, and their prevalences were compared among stroke subtypes. Outcomes were collected from the patients' medical records. ResultsThe most common stroke subtype in patients with SLE was that of undetermined causes (31%), followed by small artery occlusion (16%), cardioaortic embolism (13%), other causes (11%), lobar hemorrhaging (10%), deep hemorrhaging (10%), and large artery atherosclerosis (9%). Stroke onset occurred during a period of high SLE activity in 21 patients (30%). The proportion of patients with high SLE activity varied according to stroke subtype (p=0.039) and was highest for cerebral infarction with undetermined causes. Stroke recurrence or death was observed in 40% of patients within 5 years after the initial stroke onset. ConclusionThe contributions of SLE to stroke varied significantly according to the stroke subtype. Given the unfavorable prognosis, close stroke subtype-specific observation by rheumatologists and stroke specialists is recommended after stroke events.

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Dynamic morphological changes in Libman-Sacks endocarditis under different anticoagulation regimens

Cited by 4 publications

References 5 publications

Young Stroke Following Libman-Sacks Endocarditis associated with Systemic Lupus Erythematosus and Secondary Antiphospholipid Antibody Syndrome

Young Stroke Following Libman-Sacks Endocarditis associated with Systemic Lupus Erythematosus and Secondary Antiphospholipid Antibody Syndrome

Culture-negative endocarditis with neurologic presentations and dramatic response to heparin: a case report

Heterogeneity of Stroke in Patients with Systemic Lupus Erythematosus

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