Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access
Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc
Journal website https://www.cardiologyres.org

Case Report

Volume 8, Number 2, April 2017, pages 57-62

Lupus-Negative Libman-Sacks Endocarditis Complicated by Catastrophic Antiphospholipid Syndrome

Figures

Figure 1.
Figure 1. CT of head without contrast showing extensive multifocal areas of hypoattentuation throughout the bilateral frontal, parietal, occipital, and right > left temporal lobes. No mass effect or midline shift or hemorrhage was seen.
Figure 2.
Figure 2. 2D transesophageal ultrasound. Image on the left shows a thickened mitral valve with a 1 cm vegetation that can be seen on the anterior mitral leaflet. Image on the right is a four-chamber color flow Doppler view showing biventricular dilatation, severe left ventricular dysfunction. For orientation purposes, left ventricle is the bottom right chamber. Video of both views is attached as a supplementary file.
Figure 3.
Figure 3. MRI of the brain. Images on the top show increased signal on diffusion weighted imaging (DWI) throughout the bilateral frontal, parietal, and occipital lobes. Images on the bottom show a corresponding decreased signal intensity on apparent diffusion coefficient that is consistent with acute abnormal restricted diffusion. These findings suggest new/ongoing acute infarcts.
Figure 4.
Figure 4. Pathology slide of mitral valve vegetation. Lots of necrosis: 10 cm circumference vegetation. Mitral valve tissue shows focal necrosis. No bacterial or fungal organisms were present.
Figure 5.
Figure 5. R lung, high power: emboli and large necrotic infarcted tissue.
Figure 6.
Figure 6. Low power of the liver: lots of steatosis and congestion, necrosis.
Figure 7.
Figure 7. High power pathology slide of the liver showing lots of steatosis, congestion, and necrosis.
Figure 8.
Figure 8. Low power pathology slide of the lung showing emboli and necrotic tissue.

Table

Table 1. Laboratory Tests on Admission
 
LabValue
Sodium, mEq/L141
Potassium, mEq/L5.2
Chloride, mEq/L107
Bicarbonate, mg/dL14
BUN, mg/dL28
Creatinine, mg/dL2.86
Glucose, mg/dL186
Creatine kinase (CK), U/L8,764
Aspartate aminotransferase (AST), units/L3,603
Alanine aminotransferase (ALT), units/L220
Alkaline phosphatase, units/L83
Bilirubin, mg/dL2.4
White blood cell, cells/μL26.9
Hemoglobin, g/dL13.7
Platelets, 103/μL90,000
Peripheral smearNo schistocytes
PT, s40
INR2.5
Fibrinogen, mg/dL173
B-type natriuretic peptide (BNP), pg/mL2,089
Troponin, ng/mL213
Lactate, mg/dL10.3
Urine drug screenNegative
Alcohol level, mg/dLNegative
Acetaminophen level, μg/mLNegative
C-reactive protein (CRP), mg/dL10.6
Erythrocyte sedimentation rate (ESR), mm/h25
Complement component 3 (C3), mg/dL42
Complement component 4 (C4), mg/dL7.5
Lupus anticoagulantPositive
Anti-cardiolipin IgA, IgG, IgMNegative
Anti-B-2 glycoprotein IgA, IgG, IgMNegative
Prothrombin genotypeNo mutation
Myeloperoxidase Ab, U< 0.2
Serine proteinase 3 Ab, U< 0.2
Rheumatoid factor (RF), IU/mL< 10
Antinuclear antibodies (ANA) screen, UNegative
Anti-centromere Ab, U< 0.2
Anti-dsDNA, IU/mL1
Chromatin Ab IgG, AI< 0.2
Jo 1 Ab IgG, U< 0.2
Ribonucleoprotein (RNP) Ab, U< 0.2
Ribosomal P protein, U< 0.2
Scl-70 Ab, U< 0.2
Smith Ab, U< 0.2
Sjogren’s syndrome A, U< 0.2
Sjogren’s syndrome B, U< 0.2