Libman-Sacks endocarditis and cerebral infarction in antiphospholipid syndrome: A case report

Valvular heart disease is a considerable finding in the antiphospholipid antibody syndrome (APS). The involvement of the mitral and aortic valves is more common in the form of leaflet thickening or aseptic verrucous vegetations called the Libman-Sacks endocarditis. In addition to the detrimental effects of endocarditis on the valves, it can lead to serious thromboembolic complications. Here we report our experience with a young woman, who had a history of transient ischemic attack 2 months earlier and referred to us due to severe vaginal bleeding. On echocardiography, several irregular masses were observed on the atrial side of both mitral valve leaflets. On rheumatologic work-up, she was found to have positive anticardiolipin IgG and lupus anticoagulant. During hospitalization, the patient suffered thrombotic stroke and computed tomography (CT) scan showed a parietal lobe ischemic lesion. With evidence of positive antiphospholipid antibodies and arterial thrombosis, negative blood culture, and no fever, the diagnosis of the Libman-Sacks endocarditis was established. The patient was discharged with good general condition and received Hydroxychloroquine, Warfarin, and Prednisolone. On follow-up echocardiography, intra-cardiac masses were not detected any more and no residual neurologic deficits were found.