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Case Reports
. 2019 Jun 10:33:97.
doi: 10.11604/pamj.2019.33.97.9597. eCollection 2019.

[Libman-Sacks endocarditis superinfected: a case report]

[Article in French]
Lahatriniavo Ritchy Ramiandrisoa  1 , Haingo Freddie Richard Raveloson  1 , Daniella Masinarivo Rakotoniaina  1 , Nirina Rabearivony  2 , Solofonirina Rakotoarimanana  1
Affiliations
Case Reports

[Libman-Sacks endocarditis superinfected: a case report]

[Article in French]
Lahatriniavo Ritchy Ramiandrisoa et al. Pan Afr Med J. .

Abstract
in English, French

Libman-Sacks endocarditis is a rare cardiac manifestation systemic lupus erythematosus, in which there is a sterile vegetation in the heart valves. There is a significant risk of infective endocarditis. Our patient was a 38 year old woman with persistent fever from two months with inflammatory polyarthralgia, fixed at the wrists and ankles. She was febrile at 39 ° C, had a mitral systolic murmur 2/6 and painful swelling of the wrists and ankles. We have objectified an inflammatory syndrome, blood cultures were negative. The dosage of anti-nuclear antibody was positive with a mottled appearance, as well as anti-DNA antibodies. The Doppler echocardiography had objectified vegetations in the mitral and aortic valves. Clinical, biological and morphological improvements were obtained after antibiotic and corticosteroid combination. We can conclude that Libman-Sacks endocarditis evolution is favorable in the absence of an associated antiphospholipid syndrome (APS). Always fear in all cases a surinfection. The treatment is based on the combination antibiotic-corticosteroid-synthetic antimalarial.

L'endocardite de Libman-Sacks constitue une manifestation cardiaque peu fréquente de la maladie lupique au cours de laquelle il existe une végétation non infectieuse au niveau des valves cardiaques. Il y a un risque important d'endocardite infectieuse. Notre patiente était une femme de 38 ans, présentant une fièvre persistante et une polyarthralgie inflammatoire au niveau des poignets et des chevilles. Elle présentait un souffle systolique mitral 2 sur 6 et une tuméfaction douloureuse des poignets et des chevilles. Nous avions objectivé un syndrome inflammatoire biologique. Le dosage des anticorps anti-nucléaire était positif avec un aspect moucheté, ainsi que les anticorps anti-DNA natifs. La recherche de syndrome des anti-phospholipides (SAPL) était négative. L'échographie doppler cardiaque avait objectivé des végétations au niveau des valves mitrales et aortiques. Les améliorations clinique, biologique et morphologique n'avaient été obtenues qu'après association antibiothérapie et corticothérapie. Nous pouvons conclure que l'endocardite de Libman-Sacks est d'évolution favorable en l'absence d'un syndrome des anti-phospholipides associé. Il faut toujours craindre dans tous les cas une greffe bactérienne. Le traitement est basé sur l'association antibiothérapie-corticothérapie-antipaludéen de synthèse.

Keywords: Libman-Sacks endocarditis; infective endocarditis; systemic lupus erythematosus.

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Conflict of interest statement

Les auteurs ne déclarent aucun conflit d'intérêts.

Figures

Figure 1
Figure 1
la végétation mitrale avant le traitement
Figure 2
Figure 2
la végétation aortique avant le traitement
Figure 3
Figure 3
régression de la végétation mitrale
Figure 4
Figure 4
régression de la végétation aortique
See this image and copyright information in PMC

References

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