title: [Non-bacterial thrombotic endocarditis on the bicuspid aortic valve in a 25-year-old male with lupus anticoagulant].
abstract: Non-bacterial thrombotic endocarditis (NBTE) is characterized by presence of sterile vegetations that develop from fibrin and platelets on heart valves. The main conditions predisposing to NBTE are malignancy, autoimmune diseases and other hypercoagulable states. The authors describe a case of a 25-year-old male, in whom NBTE was diagnosed on the bicuspid aortic valve. The presence of significant aortic regurgitation and dental caries were initially suggestive of infective endocarditis; although, serial blood culture were negative and procalcytonin concentration was within normal ranges. Empiric antibiotic therapy did not result in diminishing of vegetations, similarly to the anticoagulation treatment initiated when strongly positive lupus anticoagulant was detected in laboratory findings. Aortic valve replacement was necessary. Bacteriologic examination of the excised valve was negative. Widespread fibrin masses at different stages of organization on the leaflets confirmed NBTE in histopathologic assessment. Lupus anticoagulant was probably secondary to thyroid autoimmune disease.
authors.affiliation: Józef Struś Hospital, Poznań, Poland: Department of Internal Medicine.
authors.forename: Waldemar
authors.initials: W
authors.lastname: Elikowski
authors.affiliation: Józef Struś Hospital, Poznań, Poland: Department of Cardiac Surgery.
authors.forename: Radosław
authors.initials: R
authors.lastname: Jarząbek
authors.affiliation: Karol Marcinkowski Medical University of Poznań, Poland, 2ndDepartment of Cardiology.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Małek
authors.affiliation: Józef Struś Hospital, Poznań, Poland: Department of Internal Medicine.
authors.forename: Włodzimierz
authors.initials: W
authors.lastname: Witczak
authors.affiliation: Józef Struś Hospital, Poznań, Poland: Pathomorphlogy Unit.
authors.forename: Stanisław
authors.initials: S
authors.lastname: Łazowski
authors.affiliation: Józef Struś Hospital, Poznań, Poland: Department of Internal Medicine.
authors.forename: Piotr
authors.initials: P
authors.lastname: Psuja
mesh_terms: D000328:Adult; D001021:Aortic Valve / Q000002:abnormalities* / Q000601:surgery; D000082882:Bicuspid Aortic Valve Disease; D003937:Diagnosis, Differential; D059905:Endocarditis, Non-Infective / Q000175:diagnosis* / Q000601:surgery; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D016682:Lupus Coagulation Inhibitor; D008297:Male
chemical_list: D016682:Lupus Coagulation Inhibitor
keywords: bicuspid aortic valve; lupus anticoagulant; non-bacterial thrombotic endocarditis