Hemoptysis and a cardiac murmur: is it primary or secondary antiphospholipid syndrome?

Abstract

Endocarditis is most frequently infective in origin, and thus, when a patient presents with a clinical picture suggestive of endocarditis, an extensive work up aimed at finding the infectious agent is warranted. Among systemic lupus erythematosus (SLE) patients, cardiovascular disease is prevalent in more than 50% of patients including valvular disease and non-infective endocarditis, known as Libman–Sacks (LS) endocarditis. The prevalence of LS syndrome among SLE patients with secondary antiphospholipid syndrome (APS) is higher than in SLE without APS. Here, we present a case of a patient diagnosed with primary APS who presented with hemoptysis and a cardiac murmur. The diagnosis of SLE was established following the findings of non-infective verrucous vegetations together with diffuse alveolar hemorrhage (DAH). Treatment with high-dose corticosteroids and intravenous immunoglobulins yielded substantial resolution of the vegetations and regression of the DAH. Hence, aortic valve replacement was successfully performed as an elective procedure and without any postoperative complications. The patient is in remission after a 6-month follow-up. The clinical findings of DAH and double valve non-infectious endocarditis prompted the diagnosis of SLE with secondary APS.

Preliminary Study on the Imbalance Between Th17 and Regulatory T Cells in Antiphospholipid Syndrome

“…Unfortunately, our study does not reach the same conclusion. Other studies have showed that patients with SAPS are more likely to develop more severe diffuse alveolar hemorrhage (DAH) and non-infectious endocarditis, known as Libman-Sacks (LS) endocarditis, especially in APS secondary to SLE (47,48). Only one other study reported differences in immune function between PAPS and SAPS patients, but the lower serum C3 and C4 levels in PAPS patients (9) were inconsistent with our results.…”

Treatment of a maternal in cardiogenic shock due to bacterial endocarditis combined with Libman-Sacks endocarditis ： a case report and literature review

“…It is reported that antiphospholipid antibodies may be present in 54% of patients while only 10% of SLE patients develops APS (3). Moreover, primary APS patients are also descried to have LS valve lesions (4). In addition, thrombocytopenia, one of the common manifestations of SLE, is considered to be associated with the higher incidence of valve abnormalities in patients with SLE.…”

Treatment of a pregnant patient with cardiogenic shock due to bacterial endocarditis combined with Libman-Sacks endocarditis: a case report and literature review

“…It has been reported that antiphospholipid antibodies may be present in 54% of patients, while only 10% of SLE patients develop APS (3). Moreover, LS valve lesions have been described in primary APS patients (4). In addition, thrombocytopenia, one of the common manifestations of SLE, is considered to be associated with a higher incidence of valve abnormalities in patients with SLE.…”