Mitral valve replacement due to Libman-Sacks endocarditis: lower limb cellulitis as a red herring

• Published in: BMJ case reports Vol. 15; no. 1; p. e246078
• Main Authors: Sexton, Gerard, McLoughlin, Joseph, Burke, Louise, Doddakula, Kishore
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 20.01.2022
• Subjects: Anticoagulants; Autoimmune diseases; Biopsy; Calcification; Case reports; Cellulitis; Debridement; Embolisms; Endocarditis; Female; Humans; Ischemia; Lower Extremity; Lupus; Middle Aged; Mitral Valve - diagnostic imaging; Mitral Valve - surgery; Mitral Valve Insufficiency - diagnostic imaging; Mitral Valve Insufficiency - etiology; Mitral Valve Insufficiency - surgery; Surgery; Thromboembolism; Thrombosis; Ulcers; cardiothoracic surgery; vasculitis
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2021-246078

A 56-year-old woman was admitted due to new ulceration and acute digital ischaemia on a background of chronic leg ulcers bilaterally. Vasculitis screening returned strongly positive lupus anticoagulant levels and elevated anticardiolipin antibodies; these remained elevated at repeat testing. A diagnosis of antiphospholipid syndrome was made. Transthoracic echocardiogram identified a mitral valve lesion suggestive of vegetation and mild mitral valve regurgitation. Blood cultures taken throughout her inpatient admission were negative. Mechanical mitral valve replacement was performed 3 months later, and subsequent culture of the excised tissue returned as sterile. Histological examination showed no morphological signs of infective endocarditis.