Libman-Sacks endocarditis: regression after immunosuppressive and antiplatelet therapy in a patient with newly diagnosed systemic lupus erythematosus and positive antiphospholipid antibodies

Abstract

A woman in her 40s went to the hospital due to persistent headaches. On physical examination, a diastolic murmur in the third sternal intercostal space was the only finding. Echocardiograms were performed, revealing moderate aortic regurgitation and heterogeneously echoreflectant masses of variable shape with no independent mobility, mainly located on the ventricular side of the coaptation point of the three aortic cusps. Initially, aortic septic endocarditis was diagnosed, but no evidence of infection was found. Immunology blood tests were then performed, which determined the presence of systemic lupus erythematosus along with positive antiphospholipid antibodies. The diagnosis of Libman-Sacks endocarditis (LSEn) was established. After receiving steroids, hydroxychloroquine and aspirin, the aortic valvular lesions regressed significantly. This suggests that early treatment with anti-inflammatory and antithrombotic medications in the initial phase of LSEn may prevent the progression of valve deterioration.