Severe mitral stenosis as the first manifestation of systemic lupus erythematosus in a 20-year-old woman: the value of magnetic resonance imaging in the diagnosis of Libman-Sacks endocarditis
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We report a case of severe mitral stenosis caused by Libman-Sacks endocarditis, as an initial manifestation of systemic lupus erythematosus (SLE) in a 20-year-old woman. Cardiac magnetic resonance imaging (MRI) demonstrated a thickening of the mitral valve with basal endocardial thickening exhibiting defect on first-pass perfusion short-axis acquisition and delayed enhancement in keeping with extensive fibrous endocarditis. The patient underwent successful mechanical mitral valve replacement. This case illustrates that MRI is useful in diagnosing this recognised but uncommon cardiac complication of SLE and excluding differential diagnosis such as valve tumour and infective endocarditis with perivalvular abscesses.
KeywordsSystemic lupus erythematosus Magnetic resonance imaging Libman-Sacks endocarditis Mitral stenosis
Conflict of interest
Supplementary material Movie 1. Transthoracic echocardiography. Transthoracic echocardiography showed minor hydropericardium and severe mitral stenosis due to a global thickening of the endocardium. (MPG 1488 kb)
Supplementary material Movie 2. Cardiac MRI long-axis cine. Analysis of long-axis cine views demonstrated a thickening of both the mitral valve and the surrounding endocardial tissue. (MPG 124 kb)
Supplementary material Movie 3. Cardiac MRI short-axis first-pass perfusion. First-pass perfusion short-axis acquisition showed a perfusion defect of the basal endocardium. (MPG 422 kb)