Case report of culture-negative endocarditis in lupus nephritis.
Khandait H Ong CK Javaid A Sandhu R
Khandait H
Ong CK
Javaid A
Sandhu R
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Trinitas Regional Medical Center; The Dudley Group NHS Foundation Trust; .
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Publication date
07/07/2023
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Abstract
Cardiovascular involvement is frequent in systemic lupus erythematosus (SLE). Valvular abnormalities are increasingly being recognized with the advent of echocardiography. Case Summary: We present a case of a 46-year-old lady who presented to the emergency department with upper limb ischaemia. On examination, she had poor dentition and a short systolic murmur on auscultation. A blood workup revealed a diagnosis of SLE. Further investigations showed vegetations on the mitral valve. Initially, an infective endocarditis (IE) diagnosis was made, which was treated with antibiotics. High-dose steroids and immunosuppressants were initiated due to her clinical deterioration and biopsy-proven lupus nephritis. She improved clinically before being discharged home. It can be difficult to distinguish between IE and Libman-Sacks endocarditis (LSE), especially in the setting of risk factors for both. Antibiotics and immunosuppressants might be started simultaneously in these cases. A multidisciplinary team is required to manage challenging cases of culture-negative endocarditis. Procalcitonin may have a role in differentiating bacterial endocarditis and LSE. Competing Interests: Conflict of interest: None declared. The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.
Citation
Khandait H, Ong CK, Javaid A, Sandhu R. Case report of culture-negative endocarditis in lupus nephritis. Eur Heart J Case Rep. 2023 Jul 7;7(7):ytad290. doi: 10.1093/ehjcr/ytad290. PMID: 37457053; PMCID: PMC10347674
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Article