Introduction: This case report highlights a serious complication in patients with systemic lupus erythematosus (SLE) and antiphospholipid antibody syndrome (APS). SLE is a chronic autoimmune disease affecting multiple organs, and APS is characterized by antiphospholipid antibodies that increase thrombosis risk. The patient, a 20-year-old woman with SLE and APS, presented with left upper quadrant pain and shortness of breath. Initially diagnosed with splenic infarcts, she later developed hemopericardium and cardiogenic shock. Emergent surgery revealed an aortic root abscess caused by Libman-Sacks endocarditis, a known SLE complication.
Description: The patient, tachycardic, febrile, and hypotensive, underwent CT scans showing splenomegaly and splenic infarcts. A chest CTA ruled out acute pulmonary embolism. Despite initial stabilization and preparation for discharge, the patient deteriorated and was transferred to the ICU. Bedside echo revealed hemopericardium with tamponade and cardiogenic shock. Emergency aortic root replacement was performed due to an aortic root abscess with rupture caused by Libman-Sacks endocarditis. Post-surgery, the patient recovered well.
Discussion: Libman-Sacks endocarditis, a rare complication of SLE and APS, involves sterile vegetations on heart valves, potentially leading to heart failure, valve rupture, and embolic events. Incidence ranges from 0.9% to 15% in SLE patients. Diagnosis is challenging due to non-specific manifestations, necessitating echocardiography, particularly transesophageal echocardiography, for improved sensitivity.
Management of Libman-Sacks endocarditis typically involves immunosuppressive agents for underlying SLE, while antibiotics are unnecessary due to sterile vegetations. However, severe cases may require surgical intervention, as in this case. Urgent surgery is crucial to prevent catastrophic outcomes such as aortic root abscess and rupture.
A study showed higher mortality rates in SLE patients with cardiac involvement. Therefore, prompt recognition and management of Libman-Sacks endocarditis are crucial to prevent catastrophic outcomes. Clinicians should maintain a high suspicion for this condition in SLE patients with cardiac symptoms and consider specialist referral when cardiac involvement is suspected
