Endocardial involvement as the onset of systemic lupus erythematosus: own observation and literature review

Authors

  • S.А. Trypilka Municipal Non-Profit Enterprise of Kharkiv Regional Council “Regional Clinical Hospital”, Kharkiv, Ukraine
  • Ye.D. Yehudina Institute of Rheumatology, Kyiv, Ukraine

DOI:

https://doi.org/10.22141/2224-1485.14.2.2021.231851

Keywords:

systemic lupus erythematosus, Libman-Sacks endocarditis, nonbacterial thrombotic endocarditis, diagnosis, treatment, review

Abstract

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that is characterized by inflammation and damage to many systems. Cardiac involvement in SLE is one of the many possible manifestations of this polymorphic disease and occurs in more than 50 % of these patients, affecting all structural components of the heart. The endocardium involvement in SLE is a rather rare, but at the same time it is difficult clinical manifestation for the correct interpretation of nosological affiliation. This is due, on the one hand, to the atypical nature of this lesion in SLE, when patients visit cardiologists, therapists, cardiac surgeons, receiving only symptomatic help, as in our clinical case. On the other hand, using the new classification criteria for SLE, it is possible to detect this pathology with a high degree of certainty and begin an adequate basic therapy that can lead to persistent clinical and laboratory remission and prevent the involvement of other organs and systems in the process. This paper presents a clinical observation of the SLE onset from valve lesions, late diagnosis and nosological verification of lupus endocarditis (Libman-Sacks endocarditis). A review of the literature on the management of patients with nonbacterial thrombotic endocarditis (NBTE) caused by the formation of sterile vegetations on the heart valves without any signs of infection due to endothelial damage in hypercoagulable conditions was carried out. The most common causes of NBTE are SLE, antiphospholipid syndrome, and malignant neoplasms. NBTE is usually asymptomatic and is often an incidental finding during examination or autopsy. Vegetations are more often localized on the valves of the left heart (mitral and less often aortic), but other valves can also be affected. Typical clinical manifestations are due to embolism. Treatment of these patients is based on the use of anticoagulant therapy and treatment of the underlying disease, although prospective studies have not been conducted.

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Published

2021-06-09

Issue

Section

Review