SHM Converge Scientific Abstract ePoster Gallery-Libman Sacks Endocarditis in a Patient With Systemic Lupus Erythematosus

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A 26-year-old woman with a 10-year history of systemic lupus erythematosus (SLE), end-stage renal disease on nightly peritoneal dialysis, and anemia of chronic disease presented with 9 days of bilateral lower-extremity edema. She also reported fatigue, dyspnea on exertion, nausea, and non-bloody, non-bilious vomiting for 4 days. Despite increasing dialysis duration and frequency, her edema did not improve.<br /><br />On exam, she was tachycardic but afebrile and without murmurs, rash, or skin/nail changes. Key labs showed severe anemia (Hgb 5.8), elevated pro-BNP (12,799), low calcium, and mildly elevated inflammatory markers. Cardiac evaluation with transthoracic echocardiogram showed preserved/mildly reduced LV function (LVEF 52.7%) with moderate-severe mitral regurgitation and thickened mitral valve leaflet tips suggestive of vegetations.<br /><br />Infective endocarditis was initially considered, but the patient did not meet Modified Duke Criteria: she had no fever or classic peripheral signs, and blood cultures were negative. Given her SLE history and acute mitral regurgitation, the presentation was felt to be most consistent with Libman-Sacks endocarditis, a non-bacterial thrombotic endocarditis associated with SLE.<br /><br />During hospitalization, nephrology was consulted and she received nightly inpatient peritoneal dialysis. The case highlights that Libman-Sacks endocarditis commonly involves the mitral and/or atrial valves, can cause valvular insufficiency and embolic complications, and may be difficult to distinguish from bacterial endocarditis. Early recognition is important because treatment focuses on controlling the underlying autoimmune disease and considering anticoagulation to reduce morbidity.

Asset Subtitle

Leena S. Penumalee

Meta Tag

Author List Leena S. Penumalee, Nathaniel G. Meadow

Category Clinical Vignettes

Concept Libman-Sacks Endocarditis

Concept Systemic Lupus Erythematosus

Concept Mitral Regurgitation

Concept Valvular Vegetation

Concept Infective Endocarditis

Distinguished Non-Finalist

Presenter Organization University of Chicago Pritzker School of Medicine

Presenting Author Leena S. Penumalee

Track Adult

Keywords

systemic lupus erythematosus

Libman-Sacks endocarditis

non-bacterial thrombotic endocarditis

mitral regurgitation

peritoneal dialysis

end-stage renal disease

severe anemia

echocardiogram

blood cultures negative

Modified Duke Criteria

Libman-Sacks Endocarditis

Systemic Lupus Erythematosus

Mitral Regurgitation

Valvular Vegetation

Infective Endocarditis