title: Antiphospholipid antibody-associated non-infective mitral valve endocarditis successfully treated with medical therapy.
abstract: Non-bacterial endocarditis lesions associated with antiphospholipid antibodies (aPLs) in the absence of other criteria for antiphospholipid syndrome or systemic lupus erythematosus is termed an aPL-associated cardiac valve disease. Evidence regarding the management of this condition is sparse. A rare case is described of a 20-year-old female who presented with an incidental finding of 'vegetations on a heart valve'. Echocardiography revealed mitral valve leaflet thickening and echodensities with moderate mitral regurgitation. She had an elevated partial thromboplastin time that did not correct with a mixing study, and elevated levels of antiocardiolipin antibodies. Hence, a diagnosis of aPL-associated cardiac valve disease was made, and the patient commenced on warfarin, hydroxychloroquine, and a short course of oral prednisone. At one year after diagnosis the patient remained symptom-free, and follow up echocardiography revealed resolution of the vegetations with minimal mitral regurgitation. Further evidence is needed to guide the therapy of this rare condition.
authors.affiliation: Division of Cardiology, Lehigh Valley Health Network, Allentown, Pennsylvania, USA.
authors.forename: Tahmeed
authors.initials: T
authors.lastname: Contractor
authors.forename: Adrian
authors.initials: A
authors.lastname: Bell
authors.forename: Atul
authors.initials: A
authors.lastname: Khasnis
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Silverberg
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Martinez
mesh_terms: D017153:Antibodies, Anticardiolipin / Q000097:blood; D000925:Anticoagulants / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D059905:Endocarditis, Non-Infective / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use*; D056747:Immunomodulation; D008943:Mitral Valve; D008944:Mitral Valve Insufficiency / Q000150:complications; D011241:Prednisone / Q000627:therapeutic use; D014859:Warfarin / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D017153:Antibodies, Anticardiolipin; D000925:Anticoagulants; D005938:Glucocorticoids; D006886:Hydroxychloroquine; D014859:Warfarin; D011241:Prednisone