Retinal Vasculitis With Libman-Sacks Endocarditis as Presenting Features of a Systemic Lupus Erythematosus With Antiphospholipid Antibody Syndrome Patient

    April 2024 in “ Rheumatology ”
    Md. Mazharul Islam, Sharif Ruhul Q Uddus, Mark Hughes, Rakshit Kumar
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    TLDR A young woman with visual issues and other symptoms was diagnosed with lupus and antiphospholipid syndrome, and improved with treatment.
    A 22-year-old woman presented with retinal vasculitis and Libman-Sacks endocarditis, leading to a diagnosis of systemic lupus erythematosus (SLE) with antiphospholipid antibody syndrome (APS). She had a history of visual disturbances, photosensitive rash, Raynaud’s phenomenon, significant hair loss, and a miscarriage. Examination revealed mild alopecia, a butterfly rash, and a pansystolic murmur. Blood tests showed thrombocytopenia, positive antinuclear antibodies, and high anticardiolipin and anti-beta 2 glycoprotein 1 antibodies. Imaging confirmed mitral valve vegetation and possible perforation. Treatment included methylprednisolone, prednisolone, hydroxychloroquine, mycophenolate mofetil, warfarin, and pan-retinal photocoagulation, resulting in significant symptom improvement. Early identification and multidisciplinary intervention are crucial for managing such cases.
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