Journal of General Internal Medicine

, Volume 23, Issue 6, pp 883–886 | Cite as

Establishing the Diagnosis of Libman–Sacks Endocarditis in Systemic Lupus Erythematosus

Case Reports/Clinical Vignettes



A 43-year-old female with systemic lupus erythematosus (SLE) was admitted with fever and shortness of breath 1 month after aortic valve replacement. A diagnostic workup including chemistries, complete blood count, blood cultures, chest x-ray, and 2-D echocardiogram was performed to determine the etiology of her symptoms and differentiate between acute bacterial endocarditis and Libman–Sacks endocarditis.


By utilizing Duke’s criteria, antiphospholipid antibodies, and serial echocardiography, we were able to make a diagnosis of Libman–Sacks endocarditis. The patient was successfully treated for Libman–Sacks endocarditis and recovered uneventfully.


This case highlights the challenges of making the correct diagnosis when 2 disease processes present with similar findings.


Libman–Sacks endocarditis systemic lupus erythematosus blood cultures echocardiogram 



The author would like to thank Philip Sack MD, Cardiology Fellow, Section of General Cardiology, Tulane University Medical School, for his assistance with the echocardiographic images.

Conflict of Interest

None disclosed.


  1. 1.
    Libman E, Sacks B. A hitherto undescribed form of valvular and mural endocarditis. Arch Intern Med. 1924;33:701–7.Google Scholar
  2. 2.
    Hojnik M, et al. Heart involvement (Libman Sacks endocarditis) in the antiphospholipid syndrome. Circulation. 1996;93:1579–87.PubMedGoogle Scholar
  3. 3.
    Chartash EK, et al. Aortic insufficiency and mitral regurgitation in patients with systemic lupus erythematosus and the antiphospholipid syndrome. Am J Med. 1989;86:407–12.PubMedCrossRefGoogle Scholar
  4. 4.
    Moyssakis I, et al. Libman–Sacks endocarditis in systemic lupus erythematosus: prevalence, associations, and evolution. Am J Med. 2007;120:636–42.PubMedCrossRefGoogle Scholar
  5. 5.
    Roldan CA, Shively BK, Lau CC, et al. Systemic lupus erythematosus valve disease by transesophageal echocardiography and the role of antiphospholipds antibodies. J Am Coll Cardiol. 1992;20:1127–34.PubMedCrossRefGoogle Scholar
  6. 6.
    Roldan CA, Shivley BK, Crawford MH. An echocardiographic study of valvular heart disease associated with systemic lupus erythematosus. N Engl J Med. 1996;335:1424–30.PubMedCrossRefGoogle Scholar
  7. 7.
    Farzaneh-far A, Roman MJ, Lockshin MD, et al. Relationship of antiphospholipid antibodies to cardiovascular manifestations of systemic lupus erythematosus. Arthritis Rheum. 2006;54:3918–25.PubMedCrossRefGoogle Scholar
  8. 8.
    Li JS, Sexton DJ, Mick N, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000;30:633.PubMedCrossRefGoogle Scholar
  9. 9.
    Asherson R, Cervera R. Antiphospholipid Antibodies and the Heart. Circulation. 1991;84(2):920–22.PubMedGoogle Scholar
  10. 10.
    Barnes EV, Narain S, Naranjo A, et al. High sensitivity C-reactive protein in systemic lupus erythematosus: relation to disease activity, clinical presentation and implications for cardiovascular risk. Lupus. 2005;14:576–82.PubMedCrossRefGoogle Scholar
  11. 11.
    Leszcerynski P, et al. Cardiac valvular disease in patients with systemic lupus erythematosus. Relationship with anticardiolipin antibodies. Clin Rheumatol. 2003;22(6):405–8.CrossRefGoogle Scholar
  12. 12.
    Amoroso A, Cacciapaglia F, De Castro S, et al. The adjunctive role of antiphopholpid antibodies in systemic lupus erythematosus cardiac involvement. Clin Exp Rheumatol. 2006;24(3):286–94.Google Scholar
  13. 13.
    Perez-Villa F, et al. Severe valvular regurgitation and antiphospholipid antibodies in systemic lupus erythematosus: a prospective, long-term follow up study. Arthritis Rheum. 2005;53(3):460–67.PubMedCrossRefGoogle Scholar
  14. 14.
    Paran D, Caspi D, Levartovsky D, et al. Cardiac dysfunction in patients with systemic lupus erythematosus and antiphospholipid syndrome. Ann Rheum Dis. 2007;66:506–10.PubMedCrossRefGoogle Scholar
  15. 15.
    Roland CA. Valvular disease associated with systemic illness. Cardiol Clin. 1998;16(3):531–50.CrossRefGoogle Scholar
  16. 16.
    Gonzales-Juanatey C. Libman Sacks endocarditis and primary antiphospholipid syndrome. J Heart Valve Dis. 2005;14:700–2.Google Scholar

Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  1. 1.Section of General Internal MedicineTulane University School of MedicineNew OrleansUSA

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