SHM Converge Scientific Abstract ePoster Gallery-Libman - Sacks Endocarditis With Seizures, Hypoxia, and Cardiac Arrest

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A 25-year-old woman with systemic lupus erythematosus (SLE), lupus nephritis, cardiomyopathy, prior TIA, and epilepsy was transferred to the ICU for altered mental status after presumed seizures. Her course was complicated by severe hypotension and cardiac arrest. After resuscitation, she remained encephalopathic with undifferentiated shock. Initial CT head, EEG, TTE, cardiac MRI, and infectious workup were negative.<br /><br />Brain MRI showed multifocal punctate infarcts. Although these findings were initially thought to reflect postictal changes or hypoxic brain injury from arrest, a repeat MRI five days later showed persistent diffusion abnormalities in bilateral border zones and cerebellar hemispheres, raising concern for embolic stroke. Because TTE and cardiac MRI did not show vegetations, neurology recommended a transesophageal echocardiogram (TEE), which is more sensitive for small valvular lesions.<br /><br />TEE revealed small, fixed masses on the mitral valve consistent with Libman-Sacks endocarditis (LSE), a rare noninfectious endocarditis associated with SLE and sterile platelet thrombi. Blood cultures remained negative, supporting the diagnosis. Cardiology started the patient on heparin for anticoagulation.<br /><br />This case highlights the importance of reconsidering initial assumptions in complex hospitalized patients. The patient’s neurologic findings were initially attributed to seizures and hypoxia, but persistent MRI abnormalities revealed multifocal infarcts from embolic disease. A multidisciplinary approach and awareness of anchoring bias were essential to diagnosing this rare cause of stroke in SLE.

Asset Subtitle

Isna Khaliq

Meta Tag

Author List Ashley A. Narsinghani, Isna Khaliq, Tingfei Hu

Category Clinical Vignettes

Concept Libman-Sacks Endocarditis

Concept Transesophageal Echocardiography

Concept Systemic Lupus Erythematosus

Concept Cerebral Infarction

Concept Systemic Embolism

Distinguished Non-Finalist

Presenter Organization Rush University Medical Center

Presenting Author Isna Khaliq

Track Adult

Keywords

systemic lupus erythematosus

Libman-Sacks endocarditis

embolic stroke

transesophageal echocardiogram

multifocal infarcts

mitral valve vegetations

altered mental status

cardiac arrest

lupus nephritis

anticoagulation

Libman-Sacks Endocarditis

Transesophageal Echocardiography

Systemic Lupus Erythematosus

Cerebral Infarction

Systemic Embolism