THU0593 LIBMAN SACKS ENDOCARDITIS COMPLICATED WITH CEREBRAL EMBOLISM REVEALING SYSTEMIC LUPUS ERYTHEMATOSUS: A CASE REPORT
Authors: D. Khalifa, K. Baccouche, N. El Amri, H. Zeglaoui, E. Bouajina
Journal: Annals of the Rheumatic Diseases (2020)

Background: Libman Sacks endocarditis (LS) is an uncommon sterile endocarditis mostly associated with malignancies. It can also complicate the evolution of systemic lupus erythematosus (SLE) in 1 out of 10 patients after many years of evolution of the disease. Objectives: To raise awareness of the possible rare complications of LS in SLE Methods: We report a case of a complicated Libman sacks endocarditis revealing the diagnosis of SLE. Results: A 53 years old female patient with history of hypertension was admitted to the rheumatology department for polyarthritis since 2 months with fatigue and dyspnea. On physical examination, she had no fever nor cutaneous lesions, her pulse rate was accelerated to 112 per minute and there was no heart murmur. Musculoskeletal examination revealed the presence of arthritis of little joints of the hands and bilateral arthritis of the knees. Biological results showed an accelerated sedimentation rate of 49 mm the first hour, elevated c-reactive protein of 79 mg/l, anemia and lymphopenia. Renal and hepatic functions were both normal. Transthoracic cardiac echocardiography showed no valvulopathy but a 5mm sessile vegetation on the mitral valve. To rule out infectious endocarditis, blood cultures came out negative, serological tests for brucella, parvovirus B19, coxiella brunettii, mononucleosis, were also negative. Culture of knee joint fluid for common bacteria and polymerase chain reaction tests for tuberculosis were also negative. The patient presented rapidly with agitation, cerebellar ataxia, and unilateral paresis. CT-scan showed the presence of ischemic lesions in the lenticular nucleus and the semiovale centers. Lumbar punction showed no abnormalities. She was prescribed large spectrum antibiotics and anti coagulants but with persistant worsening of her neurological state. She was then transferred to the intensive care unit. Antinuclear antibodies, came out by then positive 1:3200 with an homogenous fluorescence and with positive anti nucleosome anti bodies. The diagnosis of LS endocarditis associated with SLE complicated with brain embolisms was confirmed with delay. Conclusion: LS endocarditis is not common but when it presents it is often associated with high morbidity and mortality. Health care professionals should consider LS diagnosis in patients with underlying SLE and should be aware of the risk of embolisation. Tests to rule out infectious disease may delay initiation of appropriate treatement leading to severe prognosis. The treatment of LS endocarditis is still not well codified. References: [1]Ibrahim AM, Siddique MS. Libman Sacks Endocarditis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 [cité 27 janv 2020]. Disponible sur: http://www.ncbi.nlm.nih.gov/books/NBK532864/ [2]Gómez-Larrambe N, González-Tabarés L, Millán B, Cobelo C, Armesto V, Pousa M, et al. Libman-Sacks’ endocarditis: A frequently unnoticed complication. Nefrol Engl Ed. 1 mars 2017;37(2):217‑9. Disclosure of Interests: None declared