Libman-Sacks Endocarditis and Chordae Tendineae Rupture as Sudden Presentation of Systemic Lupus Erythematous

Abstract

Maricarmen Milan-Esteva, Laura Rodriguez, Vanessa Fonseca Ferrer, Jose Rodriguez, Jonathan Martinez, Luis Pineiro, Elizardo Matos and Maria Uzcategui

22-year-old Puerto Rican male was diagnosed with Systemic Lupus Erythematous (SLE) after presenting with gradual onset shortness of breath during the past 24 hours. Transthoracic Echocardiogram revealed moderate-severe mitral regurgitation with anterior leaflet prolapse at A1 level with suspected rupture chordae, which later was confirmed by Transesophageal Echocardiogram (TEE). Laboratory results came back positive for Antinuclear Antibody, Anti-Double stranded DNA and Neuronal Nuclear Antibody, for which Systemic Lupus Erythematous was diagnosed. Broad spectrum antibiotics were provided due to the possibility of Libman-Sacks Endocarditis debuting as SLE also was started on intravenous steroids. Patient underwent Mitral Valve Replacement instead of repair given high risk of native valve recurrent damage or complication due to his newly diagnosed connective tissue disease.

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