Endocarditis in Systemic Lupus Erythematosus

Abstract

Endocarditis is one of the most prevalent forms of cardiac involvement in patients with lupus, as it considered as a life-threatening complication. The aim of this study is to determine particularities of endocarditis in patients with lupus and to look for distinguishing features between infectious or immunological origin. A retrospective study was conducted on patients with lupus presenting endocarditis. Lupus diagnosed according to the American College of Rheumatology criteria. The diagnosis of endocarditis was made based on the modified Duke criteria. The present case report studies seven cases of endocarditis. Six of these patients are women, and the other one is a man. They are aged meanly of 29.4 years (extremes: 20-36). Fever was present in all the cases with a new cardiac murmur in six cases and a modification of its intensity in one instance. The biologic inflammatory syndrome was present in six cases. A cardiac ultrasound performed in six cases made the diagnosis of endocarditis which involved the left heart valves in five cases and the right heart valves in one instance. Valvular insufficiency was identified in six patients. The valve involvement was mitral in two cases, mitral-aortic in two others, aortic in the fifth one and tricuspid in the sixth one. Endocarditis was infectious in 4 cases, thanks to positive blood culture. The germs identified were gram-negative bacilli in two cases, the anaerobic organism in one instance and gram-positive cocci in one instance. Candida albicans was isolated in one case. Libman-Sacks endocarditis was objectified in three cases. A combination of Libman-Sacks endocarditis with infectious endocarditis was diagnosed in one instance. The treatment consisted of antibiotics in four cases with surgery in two cases. The outcome was favorable in five cases and fatal in the two others. Endocarditis in lupus can be infectious or Libman-Sacks endocarditis. These two conditions share several clinical features. The only distinctive argument remains positive blood culture. The treatment should be initiated as early as possible to limit the valve damage and improve the outcome.

A Review of Cardiac Manifestations in Patients With Systemic Lupus Erythematosus and Antiphospholipid Syndrome With Focus on Endocarditis

“…APS is characterized by recurrent venous or arterial thrombosis [ 7 ]. According to echocardiographic studies, approximately one-third of patients with primary APS had an increased prevalence of heart valve abnormalities [ 3 ].…”

“…In addition, the Duke criteria, which is a set of clinical criteria used for the diagnosis of IE, is commonly used. The Duke criteria includes major criteria (positive blood cultures for infective endocarditis, presence of typical microorganisms on two blood cultures, and evidence of endocardial involvement) and minor criteria (present with a fever greater than 38°C, predisposing heart condition or intravenous drug use, vascular and/or immunogenic phenomena, microbiologic findings, and echocardiographic findings indicative of infective endocarditis), with diagnosis based on patients meeting two major and one minor criterium, one major and three minor criterium, or five minor criterium [ 1 , 7 ]. The diagnosis of NBTE involves history and physical examination, focus on cardiac manifestations, echocardiography, and computer tomography.…”

Occult Presentation of Infective Endocarditis in Systemic Lupus Erythematosus

“…Endocarditis continues to be a predominant cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE), particularly those who are hemodialysis-dependent. 1 Given that patients with SLE are at risk for both nonbacterial thrombotic endocarditis (NBTE) and infective endocarditis, the distinction between etiologies is critical for providing appropriate therapy; however, this continues to pose a diagnostic challenge. We present a case of an 18-year-old female with combined NBTE and occult Streptococcus pyogenes (S. pyogenes ) infective endocarditis and provide a brief review of infectious and noninfectious etiologies of endocarditis.…”