CONCURRENT ACUTE MYOCARDIAL INFARCTION AND CEREBROVASCULAR ACCIDENT CAUSED BY LIBMAN-SACKS ENDOCARDITIS IN A PATIENT WITH SYSTEMIC LUPUS ERYTHEMATOSUS
CASE PRESENTATION: A 36-year-old African American female with a 3-year history of SLE (+ANA/anti-Smith/anti-dsDNA/RNP, low C3/C4, +anticardiolipin IgM/Lupus anticoagulant, +Coombs, +pericarditis, +synovitis, +nephritis) on prednisone and plaquenil but noncompliant with medical therapy, recent lupus flare, and newfound aortic valvular thickening refusing further workup presented with left chest pressure. Patient was hemodynamically stable. On exam, she had a positive systolic murmur. EKG showed
... murmur. EKG showed acute STEMI. Patient underwent urgent cardiac catheterization which showed single-vessel CAD with RCA total occlusion with evidence of spasm and thrombus. PCI was performed with multiple thrombectomies with red thrombus specimens removed. TTE showed a 2.0 x 1.2 cm mass on the aortic valve, moderate aortic regurgitation, LVEF 40-45%, and severely hypokinetic inferior and inferoseptal walls. Blood cultures were negative. Brain MRI showed 5-6 small acute right insular cortex and parietal cortical infarcts likely cardioembolic with a normal neurological exam. Libman-Sacks endocarditis (LSE) was diagnosed clinically. Aortic valve replacement was initially planned but later aborted due to the need for triple valve surgery given TEE findings of worsening valvular diseases such as severe MR, severe TR, and moderate to severe RV dysfunction. Patient remained stable with systematic anticoagulation, dual antiplatelet, and lupus management. She left against medical advice on hospital day 19 with further management as an outpatient.