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Occult systemic lupus erythematosus with active lupus nephritis presenting as Libman-Sacks endocarditis


1 Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, The Madras Medical Mission, Mogappair, Chennai, India
2 Institute of Liver, Digestive Diseases, Kidney and Organ Transplantation, The Madras Medical Mission, Mogappair, Chennai, India

Correspondence Address:
Raghavannair Suresh Kumar
The Madras Medical Mission, Institute of Cardivascular Diseases, 4 A, J. J. Nagar, Mogappair, Chennai
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2069.93720

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Year : 2012  |  Volume : 5  |  Issue : 1  |  Page : 85-88

 

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The diagnosis of systemic lupus erythematosus (SLE) depends on clinical evidence of renal, rheumatologic, cutaneous, and neurologic involvement, supported by serological markers. A previously healthy 14-year-old girl presented with Libman-Sacks endocarditis involving the aortic valve as the first manifestation of SLE. Even though she did not satisfy the American College of Rheumatology criteria for diagnosing SLE, she had anemia, proteinuria, elevated erythrocyte sedimentation rate, low complement 4 (C4) levels, and strongly positive antinuclear antibody titer. A renal biopsy showed stage IV lupus nephritis. Treatment was initiated with immunosuppressants and steroids. This type of presentation may be misdiagnosed as infective endocarditis missing the underlying collagen vascular disease.






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1 Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, The Madras Medical Mission, Mogappair, Chennai, India
2 Institute of Liver, Digestive Diseases, Kidney and Organ Transplantation, The Madras Medical Mission, Mogappair, Chennai, India

Correspondence Address:
Raghavannair Suresh Kumar
The Madras Medical Mission, Institute of Cardivascular Diseases, 4 A, J. J. Nagar, Mogappair, Chennai
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2069.93720

Rights and Permissions

The diagnosis of systemic lupus erythematosus (SLE) depends on clinical evidence of renal, rheumatologic, cutaneous, and neurologic involvement, supported by serological markers. A previously healthy 14-year-old girl presented with Libman-Sacks endocarditis involving the aortic valve as the first manifestation of SLE. Even though she did not satisfy the American College of Rheumatology criteria for diagnosing SLE, she had anemia, proteinuria, elevated erythrocyte sedimentation rate, low complement 4 (C4) levels, and strongly positive antinuclear antibody titer. A renal biopsy showed stage IV lupus nephritis. Treatment was initiated with immunosuppressants and steroids. This type of presentation may be misdiagnosed as infective endocarditis missing the underlying collagen vascular disease.






[FULL TEXT] [PDF]*


        
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