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Embolic Stroke as the Initial Manifestation of Systemic Lupus Erythematosus.

Khan RM, Namas R, Parikh S, Rubin B - Case Rep Rheumatol (2015)

Bottom Line: Autoimmune workup was positive for IF-ANA, anti-RNP, and anti-Smith antibody.She fulfilled 4/11 of the ACR criteria and met 5 of the SLICC (Systemic Lupus International Collaborating Clinics) criteria for lupus (nonscaring alopecia, thrombocytopenia, positive ANA, and positive anti-Smith and positive anti-phospholipid antibodies).This case highlights the importance of early recognition of underlying connective tissue diseases and timely management of these diseases in young patients with no previous manifestations of diseases.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Division of Rheumatology, Henry Ford Hospital, Wayne State University, Detroit, MI 48202, USA.

ABSTRACT
We present a case of a 21-year-old African-American female with no significant medical history, who presented to the emergency department with a one-week history of blurry and double vision. Ophthalmology evaluation revealed bilateral retinal artery occlusion. Further workup with imaging of the brain was consistent with an ischemic stroke. Hereditary hypercoagulable workup was unremarkable and initial testing for antiphospholipid syndrome was positive. She underwent transesophageal echocardiogram (TEE), which showed severe mitral regurgitation and thickening of mitral valve leaflets consistent with Libman-Sacks endocarditis. Autoimmune workup was positive for IF-ANA, anti-RNP, and anti-Smith antibody. She fulfilled 4/11 of the ACR criteria and met 5 of the SLICC (Systemic Lupus International Collaborating Clinics) criteria for lupus (nonscaring alopecia, thrombocytopenia, positive ANA, and positive anti-Smith and positive anti-phospholipid antibodies). This case highlights the importance of early recognition of underlying connective tissue diseases and timely management of these diseases in young patients with no previous manifestations of diseases.

No MeSH data available.


Related in: MedlinePlus

((a) and (b)) A cardiac transesophageal echocardiogram revealing severe mitral regurgitation and thickening of mitral valve leaflets with mitral valve leaflets not coapting and a small mass on the atrial side of the anterior mitral valve leaflet (arrow) suggesting Libman-Sacks endocarditis.
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fig2: ((a) and (b)) A cardiac transesophageal echocardiogram revealing severe mitral regurgitation and thickening of mitral valve leaflets with mitral valve leaflets not coapting and a small mass on the atrial side of the anterior mitral valve leaflet (arrow) suggesting Libman-Sacks endocarditis.

Mentions: The brain CT scan findings in the emergency department were consistent with an acute to subacute infarct in the posteroparietal/occipital lobe region, and the follow-up MRI showed scattered areas of restricted diffusion, suggestive of infarcts in the bilateral cerebral and cerebellar hemispheres from a likely embolic source, and focal chronic encephalomalacia changes were seen involving the right temporal-occipital lobe. MRA and MRV of brain and neck were unremarkable with no significant stenosis. Ophthalmology evaluation was positive for bilateral central retinal artery occlusion and vitreal hemorrhage (Figure 1). She underwent a TEE that showed moderate to severe mitral regurgitation with mild mitral valve thickening, mitral valve leaflets not coapting, and a small mass on the atrial side of the anterior mitral valve leaflet possibly representing old vegetation (Figure 2). The concern was raised for possible Libman-Sacks endocarditis versus infective endocarditis. Hereditary coagulopathy workup and infectious workups including three series of blood cultures, hepatitis panel, HIV screen, and Fluorescent Treponemal Antibody Absorption Test (FTA-ABS) were negative. Workup for antiphospholipid syndrome revealed positive lupus anticoagulant panel (high prothrombin time, high PTT, and high DRVVT), low titer cardiolipin IgG 23.7 (<15: absent, 15–19: inconclusive, 20–79: moderate positive, and ≥80: high positive), and negative beta 2 glycoprotein.


Embolic Stroke as the Initial Manifestation of Systemic Lupus Erythematosus.

Khan RM, Namas R, Parikh S, Rubin B - Case Rep Rheumatol (2015)

((a) and (b)) A cardiac transesophageal echocardiogram revealing severe mitral regurgitation and thickening of mitral valve leaflets with mitral valve leaflets not coapting and a small mass on the atrial side of the anterior mitral valve leaflet (arrow) suggesting Libman-Sacks endocarditis.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4525759&req=5

fig2: ((a) and (b)) A cardiac transesophageal echocardiogram revealing severe mitral regurgitation and thickening of mitral valve leaflets with mitral valve leaflets not coapting and a small mass on the atrial side of the anterior mitral valve leaflet (arrow) suggesting Libman-Sacks endocarditis.
Mentions: The brain CT scan findings in the emergency department were consistent with an acute to subacute infarct in the posteroparietal/occipital lobe region, and the follow-up MRI showed scattered areas of restricted diffusion, suggestive of infarcts in the bilateral cerebral and cerebellar hemispheres from a likely embolic source, and focal chronic encephalomalacia changes were seen involving the right temporal-occipital lobe. MRA and MRV of brain and neck were unremarkable with no significant stenosis. Ophthalmology evaluation was positive for bilateral central retinal artery occlusion and vitreal hemorrhage (Figure 1). She underwent a TEE that showed moderate to severe mitral regurgitation with mild mitral valve thickening, mitral valve leaflets not coapting, and a small mass on the atrial side of the anterior mitral valve leaflet possibly representing old vegetation (Figure 2). The concern was raised for possible Libman-Sacks endocarditis versus infective endocarditis. Hereditary coagulopathy workup and infectious workups including three series of blood cultures, hepatitis panel, HIV screen, and Fluorescent Treponemal Antibody Absorption Test (FTA-ABS) were negative. Workup for antiphospholipid syndrome revealed positive lupus anticoagulant panel (high prothrombin time, high PTT, and high DRVVT), low titer cardiolipin IgG 23.7 (<15: absent, 15–19: inconclusive, 20–79: moderate positive, and ≥80: high positive), and negative beta 2 glycoprotein.

Bottom Line: Autoimmune workup was positive for IF-ANA, anti-RNP, and anti-Smith antibody.She fulfilled 4/11 of the ACR criteria and met 5 of the SLICC (Systemic Lupus International Collaborating Clinics) criteria for lupus (nonscaring alopecia, thrombocytopenia, positive ANA, and positive anti-Smith and positive anti-phospholipid antibodies).This case highlights the importance of early recognition of underlying connective tissue diseases and timely management of these diseases in young patients with no previous manifestations of diseases.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Division of Rheumatology, Henry Ford Hospital, Wayne State University, Detroit, MI 48202, USA.

ABSTRACT
We present a case of a 21-year-old African-American female with no significant medical history, who presented to the emergency department with a one-week history of blurry and double vision. Ophthalmology evaluation revealed bilateral retinal artery occlusion. Further workup with imaging of the brain was consistent with an ischemic stroke. Hereditary hypercoagulable workup was unremarkable and initial testing for antiphospholipid syndrome was positive. She underwent transesophageal echocardiogram (TEE), which showed severe mitral regurgitation and thickening of mitral valve leaflets consistent with Libman-Sacks endocarditis. Autoimmune workup was positive for IF-ANA, anti-RNP, and anti-Smith antibody. She fulfilled 4/11 of the ACR criteria and met 5 of the SLICC (Systemic Lupus International Collaborating Clinics) criteria for lupus (nonscaring alopecia, thrombocytopenia, positive ANA, and positive anti-Smith and positive anti-phospholipid antibodies). This case highlights the importance of early recognition of underlying connective tissue diseases and timely management of these diseases in young patients with no previous manifestations of diseases.

No MeSH data available.


Related in: MedlinePlus