A Rare Case of Tricuspid Valve Libman–Sacks Endocarditis in a Pregnant Woman with Primary Antiphospholipid Syndrome
Antiphospholipid Antibody Syndrome (APS) is a systemic autoimmune disease characterized by acquired hypercoagulability with the possible development of venous, arterial, and microvascular thrombosis. We report a rare case of Libman–Sacks tricuspid valve endocarditis in a 38-year-old pregnant woman a...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-10-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/19/5875 |
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| author | Sonia Migliorini Ciro Santoro Alessandra Scatteia Santo Dellegrottaglie Antonella Tufano Vittoria Cuomo Emanuele Pilato Giuseppe Comentale Maria D’Armiento Maurizio Guida Laura Sarno |
| author_facet | Sonia Migliorini Ciro Santoro Alessandra Scatteia Santo Dellegrottaglie Antonella Tufano Vittoria Cuomo Emanuele Pilato Giuseppe Comentale Maria D’Armiento Maurizio Guida Laura Sarno |
| author_sort | Sonia Migliorini |
| collection | DOAJ |
| description | Antiphospholipid Antibody Syndrome (APS) is a systemic autoimmune disease characterized by acquired hypercoagulability with the possible development of venous, arterial, and microvascular thrombosis. We report a rare case of Libman–Sacks tricuspid valve endocarditis in a 38-year-old pregnant woman at 15 weeks gestation with unknown primary antiphospholipid syndrome. During a routine cardiac examination and echocardiography performed for a previous episode of pleuropericarditis, a large, mobile mass with irregular edges was found at the level of the tricuspid valve. Three main differential diagnoses for intramyocardial mass were examined: tumor, infective endocarditis, and nonbacterial thrombotic endocarditis (NTBE). Cardiac magnetic resonance imaging (CMR) with contrast raised the suspicion of a thrombus. The woman was hospitalized urgently at the Cardiac Intensive Care Unit of the Federico II University Hospital, and anticoagulant and antiplatelet therapy were started. The thrombophilic screening performed and medical history confirmed the diagnosis of primary antibody syndrome (APS). A multidisciplinary consultation with obstetricians, cardiologists, anesthetists, and cardiac surgeons was required. The patient decided not to terminate the pregnancy despite the risk to her health and to undergo cardiac surgery during pregnancy. Histological examination confirmed the presence of nonbacterial thrombotic endocarditis. Weekly obstetric scans were performed after surgery to verify fetal well-being. An emergency cesarean section was performed at the 35th week of gestation due to repeated deceleration and abnormal short-term variability on c-CTG in a pregnancy complicated by fetal growth restriction and gestational hypertension. A newborn weighing 1290 g was born. She was hospitalized in Neonatal Intensive Care and discharged after two months; currently, she enjoys good health. The management of patients with antiphospholipid antibody syndrome has not yet been standardized, but there is a general consensus that patients who do not have thrombocytopenia, thromboembolic phenomena, or pregnancy should not undergo any treatment or should take only low doses of acetylsalicylic acid. In the presence of any of the above conditions, various treatment regimens have been used based on the severity and individuality of the case. |
| first_indexed | 2024-03-09T21:33:04Z |
| format | Article |
| id | doaj.art-2009aece737f40f483e33469ad63a9da |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T21:33:04Z |
| publishDate | 2022-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-2009aece737f40f483e33469ad63a9da2023-11-23T20:50:19ZengMDPI AGJournal of Clinical Medicine2077-03832022-10-011119587510.3390/jcm11195875A Rare Case of Tricuspid Valve Libman–Sacks Endocarditis in a Pregnant Woman with Primary Antiphospholipid SyndromeSonia Migliorini0Ciro Santoro1Alessandra Scatteia2Santo Dellegrottaglie3Antonella Tufano4Vittoria Cuomo5Emanuele Pilato6Giuseppe Comentale7Maria D’Armiento8Maurizio Guida9Laura Sarno10Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80131 Naples, NA, ItalyDepartment of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, NA, ItalyDivision of Cardiology, “Villa dei Fiori” Hospital, 80131 Naples, NA, ItalyDivision of Cardiology, “Villa dei Fiori” Hospital, 80131 Naples, NA, ItalyDepartment of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, NA, ItalyDepartment of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, NA, ItalyDepartment of Advanced Biomedical Science, Division of Adult and Pediatric Cardiac Surgery, University of Naples Federico II, 80131 Naples, NA, ItalyDepartment of Advanced Biomedical Science, Division of Adult and Pediatric Cardiac Surgery, University of Naples Federico II, 80131 Naples, NA, ItalyPathology Unit, Department of Public Health, School of Medicine, University of Naples Federico II, 80131 Naples, NA, ItalyDepartment of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80131 Naples, NA, ItalyDepartment of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80131 Naples, NA, ItalyAntiphospholipid Antibody Syndrome (APS) is a systemic autoimmune disease characterized by acquired hypercoagulability with the possible development of venous, arterial, and microvascular thrombosis. We report a rare case of Libman–Sacks tricuspid valve endocarditis in a 38-year-old pregnant woman at 15 weeks gestation with unknown primary antiphospholipid syndrome. During a routine cardiac examination and echocardiography performed for a previous episode of pleuropericarditis, a large, mobile mass with irregular edges was found at the level of the tricuspid valve. Three main differential diagnoses for intramyocardial mass were examined: tumor, infective endocarditis, and nonbacterial thrombotic endocarditis (NTBE). Cardiac magnetic resonance imaging (CMR) with contrast raised the suspicion of a thrombus. The woman was hospitalized urgently at the Cardiac Intensive Care Unit of the Federico II University Hospital, and anticoagulant and antiplatelet therapy were started. The thrombophilic screening performed and medical history confirmed the diagnosis of primary antibody syndrome (APS). A multidisciplinary consultation with obstetricians, cardiologists, anesthetists, and cardiac surgeons was required. The patient decided not to terminate the pregnancy despite the risk to her health and to undergo cardiac surgery during pregnancy. Histological examination confirmed the presence of nonbacterial thrombotic endocarditis. Weekly obstetric scans were performed after surgery to verify fetal well-being. An emergency cesarean section was performed at the 35th week of gestation due to repeated deceleration and abnormal short-term variability on c-CTG in a pregnancy complicated by fetal growth restriction and gestational hypertension. A newborn weighing 1290 g was born. She was hospitalized in Neonatal Intensive Care and discharged after two months; currently, she enjoys good health. The management of patients with antiphospholipid antibody syndrome has not yet been standardized, but there is a general consensus that patients who do not have thrombocytopenia, thromboembolic phenomena, or pregnancy should not undergo any treatment or should take only low doses of acetylsalicylic acid. In the presence of any of the above conditions, various treatment regimens have been used based on the severity and individuality of the case.https://www.mdpi.com/2077-0383/11/19/5875Libman–Sacks endocarditispregnancythrombosisprimary antibody syndromeantiphospholipid syndrome |
| spellingShingle | Sonia Migliorini Ciro Santoro Alessandra Scatteia Santo Dellegrottaglie Antonella Tufano Vittoria Cuomo Emanuele Pilato Giuseppe Comentale Maria D’Armiento Maurizio Guida Laura Sarno A Rare Case of Tricuspid Valve Libman–Sacks Endocarditis in a Pregnant Woman with Primary Antiphospholipid Syndrome Journal of Clinical Medicine Libman–Sacks endocarditis pregnancy thrombosis primary antibody syndrome antiphospholipid syndrome |
| title | A Rare Case of Tricuspid Valve Libman–Sacks Endocarditis in a Pregnant Woman with Primary Antiphospholipid Syndrome |
| title_full | A Rare Case of Tricuspid Valve Libman–Sacks Endocarditis in a Pregnant Woman with Primary Antiphospholipid Syndrome |
| title_fullStr | A Rare Case of Tricuspid Valve Libman–Sacks Endocarditis in a Pregnant Woman with Primary Antiphospholipid Syndrome |
| title_full_unstemmed | A Rare Case of Tricuspid Valve Libman–Sacks Endocarditis in a Pregnant Woman with Primary Antiphospholipid Syndrome |
| title_short | A Rare Case of Tricuspid Valve Libman–Sacks Endocarditis in a Pregnant Woman with Primary Antiphospholipid Syndrome |
| title_sort | rare case of tricuspid valve libman sacks endocarditis in a pregnant woman with primary antiphospholipid syndrome |
| topic | Libman–Sacks endocarditis pregnancy thrombosis primary antibody syndrome antiphospholipid syndrome |
| url | https://www.mdpi.com/2077-0383/11/19/5875 |
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