A case of tricuspid valve non-bacterial thrombotic endocarditis presenting as pulmonary embolism in a patient with antiphospholipid antibody syndrome

• Published in: BMJ case reports Vol. 2018; p. bcr-2017-223860
• Main Authors: Unnikrishnan, Dileep, Shaikh, Nasreen, Sharayah, Ahmad, Patton, Chandler
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 13-03-2018; BMJ Publishing Group
• Series: Case Report
• Subjects: Anticoagulants - therapeutic use; Antiphospholipid Syndrome - diagnosis; Antiphospholipid Syndrome - drug therapy; Antiphospholipid Syndrome - physiopathology; Authorship; Autoimmune diseases; Case reports; Cough; Echocardiography; Embolisms; Endocarditis; Endocarditis, Non-Infective - diagnosis; Endocarditis, Non-Infective - drug therapy; Endocarditis, Non-Infective - physiopathology; Family medical history; Female; Fever; Glycoproteins; Heart; Humans; Immunoglobulins; Laboratories; Lupus; Middle Aged; Pain; Phosphatase; Pulmonary arteries; Pulmonary Embolism - diagnosis; Pulmonary Embolism - physiopathology; Pulmonary embolisms; Pulmonary hypertension; Rare Disease; Raynaud disease; Treatment Outcome; Tricuspid Valve - diagnostic imaging; Tricuspid Valve - pathology; Warfarin - therapeutic use; pulmonary embolism; systemic lupus erythematosus
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2017-223860

A 47-year-old woman with a medical history of Raynaud’s phenomenon presented with fever, cough and shortness of breath. She was found to have left lower lobe consolidation and pleural effusion and was treated as a case of pneumonia. During the hospital course, her respiratory status worsened, and she was intubated on the third hospital day. To investigate the high A–a gradient, a Computerized Tomographic Pulmonary Embolism (CTPE) study was done which identified a large left lower pulmonary artery embolism. She was also found to have a new murmur, and an echocardiogram demonstrated a large lesion on tricuspid valve. However, multiple sets of her blood cultures came back consistently negative. Alternative diagnoses for culture-negative endocarditis were considered, and a full set of rheumatological workup was done. Laboratory tests were suggestive of antiphospholipid syndrome, hence the diagnosis of tricuspid valve Libman-Sacks endocarditis was made.