Libman–Sacks Vegetation, Infective Vegetation, and Pulmonic Valve Abscess in a Systemic Lupus Erythematosus Patient on Immunosuppressive Therapy

Abstract

A 14-year-old girl, who is a known case of systemic lupus erythematosus and lupus nephritis, was admitted with complaints of fever for 10 days. Clinical examination did not show any focus of infection. Blood culture and sensitivity showed Staphylococcus aureus septicemia. She was started on antibiotics and subjected to routine transthoracic echocardiography. Transthoracic echocardiography showed Libman–Sacks vegetations (also known as nonbacterial thrombotic endocarditis) on all the cusps of both mitral and tricuspid valves, along with sessile freely mobile infective vegetation attached to the right ventricular free wall, and pulmonic valve abscess moving to and fro about the pulmonic annulus. Surgery was deferred due to poor general condition, and the patient was continued on parenteral therapy. The girl succumbed to her illness on the 6th day of her illness.

Keywords

• infective endocarditis in systemic lupus erythematosus
• libman–sacks endocarditis
• pulmonic valve abscess