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

Abstract

Background As one of the most common cardiac manifestations of systemin lupus erythematous (SLE), Libman-Sacks (LS) endocarditis is a non-bacterial form of thrombotic endocarditis characterized by sterile vegetations deposited on heart valves consisting of fibrin mixed with immune complexes and platelets. Although patients with LS endocarditis usually have no significant valvular, persistent LS endocarditis may be complicated by bacterial endocarditis, leading to serious complications including acute valve regurgitation, acute heart failure, and even cardiogenic shock, which were rare in maternal. Therefore, such case with atypical SLE manifestations combining with various complications deserves more attention. Case presentation We reported a rare case of a maternal without SLE history who progressed to cardiogenic shock resulting in preterm. After delivery of fetus, she was considered as bacterial endocarditis according to the results of lab tests and echocardiography. Then, LS endocarditis was also found after surgery. Moreover, SLE with catastrophic antiphospholipid syndrome (CAPS) was also confirmed during the course of treatment. Finally, Combined use of methylprednisolone and human immunoglobulin injection was carried out and the patient’s condition improved and discharged on the 13th post-operative day. Conclusion The interference of infective endocarditis with the type of pre-existing lesion in the disease process can influence our judgement and treatment decisions, which is worth noting.