Skip to main content
PMC home page
Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 1988 Nov;47(11):947–953. doi: 10.1136/ard.47.11.947

Diagnostic and therapeutic problems in two patients with antiphospholipid antibodies, heart valve lesions, and transient ischaemic attacks.

R A Asherson 1, D G Gibson 1, D W Evans 1, E Baguley 1, G R Hughes 1
PMCID: PMC1003638  PMID: 3144942

Abstract

Two young women (aged 32 and 25 years) with systemic lupus erythematosus and heart valve lesions in association with antiphospholipid antibodies are presented. In addition to the presence of the 'lupus anticoagulant' and false positive Venereal Disease Research Laboratory (VDRL) tests, both patients had high levels of IgG anticardiolipin antibodies. The first patient additionally had contraceptive induced chorea, chorea gravidarum, seven miscarriages, livedo reticularis, pulmonary embolism, and thrombocytopenia and developed culture negative endocarditis as well as hypertension. The second patient, who had presented with hypertension, developed aortic and mitral regurgitation, suspected myocarditis, manifested transient ischaemic attacks, and responded well to anticoagulation and steroid treatment.

Full text

PDF
947

Images in this article

948Image
on p.948
949Image
on p.949
950Image
on p.950
951Image
on p.951

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson D., Bell D., Lodge R., Grant E. Recurrent cerebral ischemia and mitral valve vegetation in a patient with antiphospholipid antibodies. J Rheumatol. 1987 Aug;14(4):839–841. [PubMed] [Google Scholar]
  2. Asherson R. A., Harris E. N. Anticardiolipin antibodies--clinical associations. Postgrad Med J. 1986 Dec;62(734):1081–1087. doi: 10.1136/pgmj.62.734.1081. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Asherson R. A., Harris E. N., Hughes G. R., Farquharson R. G. Complications of oral contraceptives and antiphospholipid antibodies: reply to the letter by Bruneau et al. Arthritis Rheum. 1988 Apr;31(4):575–576. doi: 10.1002/art.1780310424. [DOI] [PubMed] [Google Scholar]
  4. Asherson R. A., Harris N. E., Gharavi A. E., Hughes G. R. Systemic lupus erythematosus, antiphospholipid antibodies, chorea, and oral contraceptives. Arthritis Rheum. 1986 Dec;29(12):1535–1536. doi: 10.1002/art.1780291221. [DOI] [PubMed] [Google Scholar]
  5. Asherson R. A., Lubbe W. F. Cerebral and valve lesions in SLE: association with antiphospholipid antibodies. J Rheumatol. 1988 Apr;15(4):539–543. [PubMed] [Google Scholar]
  6. BERGEN S. S., Jr Pericardial effusion, a manifestation of systemic lupus erythematosus. Circulation. 1960 Jul;22:144–150. doi: 10.1161/01.cir.22.1.144. [DOI] [PubMed] [Google Scholar]
  7. Bernhard G. C., Lange R. L., Hensley G. T. Aortic disease with valvular insufficiency as the principal manifestation of systemic lupus erythematosus. Ann Intern Med. 1969 Jul;71(1):81–87. doi: 10.7326/0003-4819-71-1-81. [DOI] [PubMed] [Google Scholar]
  8. Bomalaski J., Talano J. V., Perlman S. New heart murmur and fever in a patient with systemic lupus erythematosus. Arch Intern Med. 1982 Apr;142(4):823–824. [PubMed] [Google Scholar]
  9. Borenstein D. G., Fye W. B., Arnett F. C., Stevens M. B. The myocarditis of systemic lupus erythematosus: association with myositis. Ann Intern Med. 1978 Nov;89(5 Pt 1):619–624. doi: 10.7326/0003-4819-89-5-619. [DOI] [PubMed] [Google Scholar]
  10. Brown J. H., Doherty C. C., Allen D. C., Morton P. Fatal cardiac failure due to myocardial microthrombi in systemic lupus erythematosus. Br Med J (Clin Res Ed) 1988 May 28;296(6635):1505–1505. doi: 10.1136/bmj.296.6635.1505. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Bulkey B. H., Roberts W. C. Systemic lupus erythematosus as a cause of severe mitral regurgitation. New problem in an old disease. Am J Cardiol. 1975 Feb;35(2):305–308. doi: 10.1016/0002-9149(75)90018-1. [DOI] [PubMed] [Google Scholar]
  12. Cronin M. E., Biswas R. M., Van der Straeton C., Fleisher T. A., Klippel J. H. IgG and IgM anticardiolipin antibodies in patients with lupus with anticardiolipin antibody associated clinical syndromes. J Rheumatol. 1988;15(5):795–798. [PubMed] [Google Scholar]
  13. D'Alton J. G., Preston D. N., Bormanis J., Green M. S., Kraag G. R. Multiple transient ischemic attacks, lupus anticoagulant and verrucous endocarditis. Stroke. 1985 May-Jun;16(3):512–514. doi: 10.1161/01.str.16.3.512. [DOI] [PubMed] [Google Scholar]
  14. Estes D., Christian C. L. The natural history of systemic lupus erythematosus by prospective analysis. Medicine (Baltimore) 1971 Mar;50(2):85–95. doi: 10.1097/00005792-197103000-00001. [DOI] [PubMed] [Google Scholar]
  15. Ford P. M., Ford S. E., Lillicrap D. P. Association of lupus anticoagulant with severe valvular heart disease in systemic lupus erythematosus. J Rheumatol. 1988 Apr;15(4):597–600. [PubMed] [Google Scholar]
  16. Fox I. S., Spence A. M., Wheelis R. F., Healey L. A. Cerebral embolism in Libman-Sacks endocarditis. Neurology. 1980 May;30(5):487–491. doi: 10.1212/wnl.30.5.487. [DOI] [PubMed] [Google Scholar]
  17. Gorelick P. B., Rusinowitz M. S., Tiku M., McDonald L. W., Robbins L. Embolic stroke complicating systemic lupus erythematosus. Arch Neurol. 1985 Aug;42(8):813–815. doi: 10.1001/archneur.1985.04210090081022. [DOI] [PubMed] [Google Scholar]
  18. Harris E. N., Asherson R. A., Hughes G. R. Antiphospholipid antibodies--autoantibodies with a difference. Annu Rev Med. 1988;39:261–271. doi: 10.1146/annurev.me.39.020188.001401. [DOI] [PubMed] [Google Scholar]
  19. Kahan A., Amor B., de Vernejoul F., Saporta L. Libman-Sacks endocarditis: the diagnostic importance of two-dimensional echocardiography. Br J Rheumatol. 1985 May;24(2):187–190. doi: 10.1093/rheumatology/24.2.187. [DOI] [PubMed] [Google Scholar]
  20. Lehman T. J., Palmeri S. T., Hastings C., Klippel J. H., Plotz P. H. Bacterial endocarditis complicating systemic lupus erythematosus. J Rheumatol. 1983 Aug;10(4):655–658. [PubMed] [Google Scholar]
  21. Lerman B. B., Thomas L. C., Abrams G. D., Pitt B. Aortic stenosis associated with systemic lupus erythematosus. Am J Med. 1982 Apr;72(4):707–710. doi: 10.1016/0002-9343(82)90485-5. [DOI] [PubMed] [Google Scholar]
  22. Lubbe W. F., Walker E. B. Chorea gravidarum associated with circulating lupus anticoagulant: successful outcome of pregnancy with prednisone and aspirin therapy. Case report. Br J Obstet Gynaecol. 1983 May;90(5):487–490. doi: 10.1111/j.1471-0528.1983.tb08950.x. [DOI] [PubMed] [Google Scholar]
  23. Murray F. T., Fuleihan D. S., Cornwall C. S., Pinals R. S. Acute mitral regurgitation from ruptured chordae tendineae in systemic lupus erythematosus. J Rheumatol. 1975 Dec;2(4):454–459. [PubMed] [Google Scholar]
  24. Myerowitz P. D., Michaelis L. L., McIntosh C. L. Mitral valve replacement for mitral regurgitation due to Libman-Sacks endocarditis. Report of a case. J Thorac Cardiovasc Surg. 1974 Jun;67(6):869–874. [PubMed] [Google Scholar]
  25. Oh W. M., Taylor R. T., Olsen G. J. Aortic regurgitation in systemic lupus erythematosus requiring aortic valve replacement. Br Heart J. 1974 Apr;36(4):413–416. doi: 10.1136/hrt.36.4.413. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Paget S. A., Bulkley B. H., Grauer L. E., Seningen R. Mitral valve disease of systemic lupus erythematosus. A cause of severe congestive heart failure reversed by valve replacement. Am J Med. 1975 Jul;59(1):134–139. doi: 10.1016/0002-9343(75)90331-9. [DOI] [PubMed] [Google Scholar]
  27. Pritzker M. R., Ernst J. D., Caudill C., Wilson C. S., Weaver W. F., Edwards J. E. Acquired aortic stenosis in systemic lupus erythematosus. Ann Intern Med. 1980 Sep;93(3):434–436. doi: 10.7326/0003-4819-93-3-434. [DOI] [PubMed] [Google Scholar]
  28. Shapiro R. F., Gamble C. N., Wiesner K. B., Castles J. J., Wolf A. W., Hurley E. J., Salel A. F. Immunopathogenesis of Libman-Sacks endocarditis. Assessment by light and immunofluorescent microscopy in two patients. Ann Rheum Dis. 1977 Dec;36(6):508–516. doi: 10.1136/ard.36.6.508. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Shulman H. J., Christian C. L. Aortic insufficiency in systemic lupus erythematosus. Arthritis Rheum. 1969 Apr;12(2):138–146. doi: 10.1002/art.1780120210. [DOI] [PubMed] [Google Scholar]
  30. Thandroyen F. T., Matisonn R. E., Weir E. K. Severe aortic incompetence caused by systemic lupus erythematosus. A case report. S Afr Med J. 1978 Jul 22;54(4):166–168. [PubMed] [Google Scholar]
  31. Tsokos G. C., Tsokos M., le Riche N. G., Klippel J. H. A clinical and pathologic study of cerebrovascular disease in patients with systemic lupus erythematosus. Semin Arthritis Rheum. 1986 Aug;16(1):70–78. doi: 10.1016/0049-0172(86)90041-7. [DOI] [PubMed] [Google Scholar]
  32. Vaughton K. C., Walker D. R., Sturridge M. F. Mitral valve replacement for mitral stenosis caused by Libman-Sacks endocarditis. Br Heart J. 1979 Jun;41(6):730–733. doi: 10.1136/hrt.41.6.730. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Waisman G., Catoggio L. J., Fongi E. G., Belziti C., Precerutti J. A. Systemic lupus erythematosus and endocarditis. Clin Exp Rheumatol. 1986 Jul-Sep;4(3):292–294. [PubMed] [Google Scholar]
  34. YURCHAK P. M., LEVINE S. A., GORLIN R. CONSTRICTIVE PERICARDITIS COMPLICATING DISSEMINATED LUPUS ERYTHEMATOSUS. Circulation. 1965 Jan;31:113–118. doi: 10.1161/01.cir.31.1.113. [DOI] [PubMed] [Google Scholar]
  35. Yamabe H., Kikuchi K., Sugawara N., Ozawa K., Kubota H., Fukushi K., Yamanaka T., Umemura Y., Onodera K., Takahashi G. Systemic lupus erythematosus complicated with pulmonary thromboembolism originating from verrucae of Libman-Sacks endocarditis. Nihon Jinzo Gakkai Shi. 1984 Mar;26(3):323–331. [PubMed] [Google Scholar]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Publishing Group

RESOURCES