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Hemoptysis and a cardiac murmur: is it primary or secondary antiphospholipid syndrome?

Authors
  • Kolitz, T1
  • Fruchter, O2, 3
  • Sasson, L4, 3
  • Geva, Y5, 3
  • Moreh-Rahav, O6, 3
  • Zandman-Goddard, G1, 3
  • 1 Department of Medicine C, Wolfson Medical Center, Holon, Israel. , (Israel)
  • 2 Department of Pulmonology, Wolfson Medical Center, Holon, Israel. , (Israel)
  • 3 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. , (Israel)
  • 4 Department of Cardiothoracic Surgery, Wolfson Medical Center, Holon, Israel. , (Israel)
  • 5 Department of Cardiology, Wolfson Medical Center, Holon, Israel. , (Israel)
  • 6 Department of Radiology, Wolfson Medical Center, Holon, Israel. , (Israel)
Type
Published Article
Journal
Lupus
Publisher
SAGE Publications
Publication Date
Dec 01, 2019
Volume
28
Issue
14
Pages
1712–1715
Identifiers
DOI: 10.1177/0961203319887229
PMID: 31718483
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Endocarditis is most frequently infective in origin, and thus, when a patient presents with a clinical picture suggestive of endocarditis, an extensive work up aimed at finding the infectious agent is warranted. Among systemic lupus erythematosus (SLE) patients, cardiovascular disease is prevalent in more than 50% of patients including valvular disease and non-infective endocarditis, known as Libman-Sacks (LS) endocarditis. The prevalence of LS syndrome among SLE patients with secondary antiphospholipid syndrome (APS) is higher than in SLE without APS. Here, we present a case of a patient diagnosed with primary APS who presented with hemoptysis and a cardiac murmur. The diagnosis of SLE was established following the findings of non-infective verrucous vegetations together with diffuse alveolar hemorrhage (DAH). Treatment with high-dose corticosteroids and intravenous immunoglobulins yielded substantial resolution of the vegetations and regression of the DAH. Hence, aortic valve replacement was successfully performed as an elective procedure and without any postoperative complications. The patient is in remission after a 6-month follow-up. The clinical findings of DAH and double valve non-infectious endocarditis prompted the diagnosis of SLE with secondary APS.

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