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Libman–Sacks endocarditis as the first manifestation of systemic lupus erythematosus in an adolescent, with a review of the literature

Published online by Cambridge University Press:  18 July 2012

Jayendra Sharma ,
Zoran Lasic ,
Abraham Bornstein ,
Rubin Cooper  and
Jonathan Chen
Jayendra Sharma*
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Jamaica Hospital Medical Center, Jamaica
Zoran Lasic
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Jamaica Hospital Medical Center, Jamaica
Abraham Bornstein
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Cohen Children's Hospital of New York, Hofstra North Shore LIJ School of Medicine, New York, United States of America
Rubin Cooper
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Cohen Children's Hospital of New York, Hofstra North Shore LIJ School of Medicine, New York, United States of America
Jonathan Chen
Affiliation:
Division of Pediatric Cardiology and Cardiothoracic Surgery, Department of Pediatrics, The New York Presbyterian Hospital – Weill Medical College, New York, New York, United States of America
*
Correspondence to: Dr J. Sharma, MD, FACC, Division of Pediatric Cardiology, Department of Pediatrics, Jamaica Hospital Medical Center, 8900 Van Wyck Expressway, Jamaica, New York 11418, United States of America. Tel: +718 206 7138; Fax: +718 206 7144; E-mail: [email protected]
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Abstract

Libman–Sacks endocarditis is rare in children and adolescents, more so as a first manifestation of systemic lupus erythematosus. Currently, sterile verrucous lesions of Libman–Sacks endocarditis are recognised as a cardiac manifestation of both systemic lupus erythematosus and antiphospholipid syndrome. They are clinically silent in a majority of the cases. The presence of antiphospholipid antibodies in systemic lupus erythematosus is associated with three times higher prevalence of mitral valve nodules and significant mitral regurgitation. We present the case of isolated mitral regurgitation with abnormal looking mitral valve, detected in early childhood, which deteriorated to a severe degree in the next decade and was diagnosed as Libman–Sacks endocarditis after surgical repair from histopathology. The full-blown clinical spectrum of systemic lupus erythematosus with antiphospholipid antibodies was observed several weeks after cardiac surgery. We discuss the atypical course of Libman–Sacks endocarditis with follow-up for 10 years, along with a review of the literature.

Keywords

Verrucous endocarditisantiphospholipid antibody syndromemitral valve repair
Type
Review Article
Information
Cardiology in the Young , Volume 23 , Issue 1 , February 2013 , pp. 1 - 6
Copyright
Copyright © Cambridge University Press 2012

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References

1. Moder, KG, Miller, TD, Tazelaar, HD. Cardiac involvement in SLE. Mayo Clin Proc 1999; 74: 275–284.Google Scholar
2. Moyssakis, I, Tektonidou, MG, Vasilliou, VA, Samarkos, M, Votteas, V, Moutsopoulos, HM. Libman–Sacks endocarditis in SLE: prevalence, association and evolution. Am J Med 2007; 120: 636–642.Google Scholar
3. Durand, I, Blaysat, G, Chauvaud, S, Tron, P, Kachner, J. Extensive fibrous endocarditis as first manifestation of systemic lupus erythematosus. Arch Fr Pediatr 1993; 50: 685–688.Google Scholar
4. Jordan, JM, Valenstein, P, Kredich, DW. Systemic lupus erythematosus with Libman–Sacks endocarditis in a 9 months old infant with neonatal lupus erythematosus and congenital heart block. Pediatrics 1989; 84: 574–578.Google Scholar
5. Kriebel, T, Sasse, M, Fink, C, Paul, T, Holtvogt, J, Hausdorf, G. Systemic lupus erythematosus-associated endocarditis in a 7 year old girl. Klin Pediatr 2002; 214: 93–96.Google Scholar
6. D'Alton, JG, Preston, DN, Bormanis, J, Green, MS, Kraag, GR. Multiple transient ischemic attacks, lupus anticoagulant and verrucous endocarditis. Stroke 1985; 16: 512–514.Google Scholar
7. Libman, E, Sacks, B. A hitherto undescribed form of valvular and mural endocarditis. Arch Intern Med 1924; 33: 701–737.Google Scholar
8. Moaref, AR, Afifi, S, Rezaian, S, Rezaian, GR. Isolated tricuspid valve LSE and valvular stenosis: unusual manifestation of SLE. J Am Soc Echocardiogr 2010; 23: 341, e3-5.CrossRefGoogle Scholar
9. Bulkley, BH, Roberts, WC. The heart in SLE and changes induced in it by corticosteroid therapy: a study of 36 necropsy patients. AM J Med 1975; 58: 243–264.Google Scholar
10. Galve, E, Candell-Riera, J, Pigrau, C, Soler-soler, J, Permanyer-Miralda, G, Garcia-Del-Castillo, H. Prevalence, morphologic types and evolution of cardiac valvular disease in SLE. N Eng J Med 1988; 319: 817–823.Google Scholar
11. Bouma, W, Klinkenberg, T, Erasmus, ME, et al. Mitral valve surgery for mitral regurgitation caused by Libman–Sacks endocarditis: a report of 4 cases and systemic review of literature. J Cardiothoracic Surg 2010; 5: 1–13.Google Scholar
12. Lee, T, Von scheven, E, Sandborg, C. Systemic lupus erythematosus and antiphospholipid syndrome in children and adolescents. Curr Opin Rheumatol 2001; 13: 415–421.Google Scholar
13. Hojnik, M, George, J, Ziporen, L, Shoenfeld, Y. Heart valve involvement (Libman–Sacks endocarditis) in the antiphospholipid syndrome. Circulation 1996; 93: 1579–1587.Google Scholar
14. Farzaneh-Far, A, Roman, MJ, Lockshin, MD, et al. Relationship of antiphospholipid antibodies to cardiovascular manifestations of systemic lupus erythematosus. Arthritis Rheum 2006; 54: 3918–3925.Google Scholar
15. Bidani, AK, Roberts, JL, Schwartz, MM, Lewis, EJ. Immunopathology of cardiac lesions in fatal SLE. Am J Med 1980; 69: 849–858.Google Scholar
16. Khamashta, MA, Cervera, R, Asherson, RA, et al. Association of antibodies against phospholipids with heart valve disease in SLE. Lancet 1990; 335: 1541–1544.Google Scholar
17. Doherty, NE, Seigel, RJ. Cardiovascular manifestation of SLE. Am Heart J 1985; 110: 1257–1265.Google Scholar
18. Gianviti, A, Barsotti, P, Barbera, V, Paraggiana, T, Rizzoni, G. Delayed onset of SLE in patients with “full house” nephropathy. Pediatr Nephrol 1999; 13: 683–687.Google Scholar
19. Nakahara, C, Hayashi, D, Matsui, A, et al. Delayed onset of SLE in a child with endothelial tubuloreticular inclusions. Clin Nephrol 2001; 56: 332–335.Google Scholar
20. Myerowitz, PD, Michaelis, LL, McIntosh, CL. Mitral valve replacement for mitral regurgitation due to Libman–Sacks endocarditis – report of case. J Thorac Cardiovasc Surg 1974; 67: 869–874.CrossRefGoogle ScholarPubMed
21. Myones, BL. Update on antiphospholipid syndrome in children. Curr Rheumatol Rep 2011; 13: 86–89.Google Scholar
22. Colli, A, Mestres, CA, Espinosa, G, et al. Heart valve surgery in patients with the antiphospholipid syndrome: analysis of a series of nine cases. Eur J Cardiothorac Surg 2010; 37: 154–158.Google Scholar
23. Perier, P, Jeserich, M, Vieth, M, Pohle, K, Hohenberger, W, Diegeler, A. Mitral valve reconstruction in patient with Libman–Sacks endocarditis: a case report. J Heart Valve Dis 2011; 20: 103–106.Google Scholar

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