Isolated tricuspid valve Libman-Sacks endocarditis in a patient with antiphospholipid antibody syndrome

Description

A 30 year-old woman presented with an episode of transient ischaemic attack (TIA). She had a history of four consecutive first trimester abortions over the past 5 years and had no live issues. A physical examination revealed livedo reticularis on her palms and feet (figure 1). On cardiac auscultation, a pansystolic murmur was heard in the tricuspid area. The remainder of the physical examination was unremarkable. The patient denied any history of dyspnoea, palpitations or swelling of the feet. She had leucopenia and thrombocytopenia with a platelet count of 80 x10⁹/L. Rheumatological evaluation yielded a positive lupus anticoagulant and elevated IgG anticardiolipin antibody levels (>300 U/mL). However, testing for antinuclear antibody and antibodies against IgM anticardiolipin and beta-2-glycoprotein 1 yielded negative results. Screening for secondary causes of positive antiphospholipid antibodies was unremarkable including a negative work-up for systemic lupus erythematosus (SLE). Brain imaging was also normal. Echocardiography was done that revealed mildly thickened...

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