[Libman-Sachs endocarditis and ischemic stroke: A case report]

Abstract

Libman-Sacks endocarditis is a rare cardiac manifestation of anti-phospholipid syndromes, in which non-infectious thrombotic vegetations are found on the heart valves. Most patients are asymptomatic whereas the risk of thromboembolism is considerable. Diagnostic work-up is based on questioning and clinical examination data looking for extracardiac signs, biological data and also on imaging, and, above all, echocardiography. We report the case of a 47-year-old female patient with no known history who is admitted to hospital with paresthesia of the right hemi-body associated with dysarthria. Cerebral CT scan confirms a paraventricular ischemic stroke. The etiological work-up for stroke is negative except the transesophageal echocardiogram which reveals mitral valve vegetations. Further investigations lead to the diagnosis of Libman-Sacks endocarditis. Treatment with Coumadin is started, with a target INR of between 2 and 3, as recommended. The clinical course was favourable, with stable lesions on transoesophageal echocardiography carried out later.

Keywords: Accident vasculaire cérébral cryptogénétique; Antiphospholipid syndrome; Cryptogenetic stroke; Endocardite; Endocardite de Libman-Sacks; Endocardite non infectieuse; Endocardite thrombotique non bactérienne; Endocarditis; Libman-Sacks endocarditis; Non-infectious endocarditis; Non-infectious thrombotic endocarditis; Syndrome des anti-phospholipides; Transesophageal echocardiography; Échographie transoesophagienne.