Twenty to 40% of patients with infective endocarditis (IE) suffer from neurologic complications. Also many and various markers of immunologic activation have been reported in patients with IE and no history of autoimmune or other rheumatologic diseases. The authors present a case of a patient suffering from IE complicated with major cerebrovascular event with concomitant appearance of lupus anticoagulant (LAC). After successful antibiotic treatment there was major clinical improvement with disappearance of LAC. LAC could be added to the list of immunologic markers appearing in the course of infective endocarditis.
Get full access to this article
View all access options for this article.
References
1.
Hoen B, Selton-Suty C, Lacassin F, et al: Infective endocarditis in patients with negative blood cultures: Analysis of 88 cases from a one-year nationwide survey in France. Clin Infect Dis20:501-506, 1995.
2.
Mylonakis E, Calderwood S: Infective endocarditis in adults. N Engl J Med345:1318-1330, 2001.
3.
Frontera JA, Gradon JD: Right-side endocarditis in injection drug users: Review of proposed mechanisms of pathogenesis. Clin Infect Dis303:374-379, 2000.
4.
Strom BL, Abrutyn E, Berlin JA, et al: Risk factors for infective endocarditis: Oral hygiene and nondental exposures. Circulation102:2842-2848, 2000.
5.
Manoff SB, Vlahov D, Herskowitz A, et al: Human immunodeficiency virus infection and infective endocarditis among injecting drug users. Epidemiology7:566-570, 1996.
6.
de Corla-Souza A, Cunha BA: Streptococcal viridans subacute bacterial endocarditis associated with anti-neutrophilic cytoplasmic autoantibodies (ANCA). Heart Lung32:140-143, 2003.
7.
Asherson RA, Tikly M, Staub H, et al: Infective endocarditis, rheumatoid factor, and anticardiolipin antibodies. Ann Rheum Dis49:107-108, 1990.
8.
Agarwal A, Clements J, Sedmak DD, et al: Subacute bacterial endocarditis masquerading as type III essential mixed cryoglobulinemia. J Am Soc Nephrol8:1971-1976, 1997.
9.
Salgado AV, Furlan AJ, Keys TF, et al: Neurologic complications of endocarditis: A 12-year experience. Neurology39:173-178, 1989.
Pruitt AA, Rubin RH, Karchmer AW, et al: Neurologic complications of bacterial endocarditis. Medicine (Baltimore)57:329-343, 1978.
12.
Heiro M, Nikoskelainen J, Engblom E, et al: Neurologic manifestations of infective endocarditis. A 17-year experience in a teaching hospital in Finland. Arch Intern Med160:2781-2787, 2000.
13.
Oppenheimer SM, Lima J: Neurology and the heart. J Neurol Neurosurg Psychiatry64:289-297, 1998.
14.
Vuille C, Nidorf M, Weyman AE, et al: Natural history of vegetations during successful medical treatment on endocarditis. Am Heart J128:1200-1209, 1994.
15.
Roder B, Wandall D, Espersen F, et al: Neurologic manifestations in Staphylococcus aureus endocarditis: A review of 260 bacteremic cases in non-drug addicts. Am J Med102:379-386, 1997.
16.
Eishei K, Kawazoe K, Kuriyma Y, et al: Surgical management of infective endocarditis associated with cerebral complications. Multicenter retrospective study in Japan. J Thorac Cardiovasc Surg110:1745-1755, 1995.
17.
Asherson RA, Gibson DG, Evans DW, et al: Diagnostic and therapeutic problems in two patients with antiphospholipid antibodies, heart valve lesions, and transient ischemic attacks. Ann Rheum Dis47:947-953, 1988.
18.
Pope JM, Canny CL, Bell DA: Cerebral ischemic events associated with endocarditis, retinal vascular disease and lupus anticoagulant. Am J Med90:299-309, 1991.
19.
Choi HK, Lamprecht P, Niles JL, et al: Subacute bacterial endocarditis with positive cytoplasmic antineutrophilic cytoplasmic antibodies and antiproteinase 3 antibodies. Arthritis Rheum43:226-231, 2000.
20.
Messias-Reason IJ, Hayashi SY, Nisihara RM, et al: Complement activation in infective endocarditis: Correlation with extracardiac manifestations and prognosis. Clin Exp Immunol127:310-315, 2002.
21.
Kupferwasser LI, Hafner G, Mohr Kahaly S, et al: The presence of infection-related antiphospholipid antibodies in infective endocarditis determines a major risk factor for embolic events. J Am Coll Cardiol33:1365-1371, 1999.
