A case of systemic lupus erythematosus mimicking the features of infective endocarditis.

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A case of systemic lupus erythematosus (SLE) mimicking the features of infective endocarditis (IE) was reported.A 38-years-old female who had suffered from rheumatic fever in childhood received the first mitral valve replacement for her remnant rheumatic valvular disease in 1967. In 1981, she visited first our hospital complaining of her joint pains and was diagnosed as rheumatoid arthritis. She also had proteinuria and hematuria, therefore renal biopsy was done. Histological diagnosis was IgA nephropathy. The second mitral valve replacement was performed on August in 1985 because of large intraventricular thrombosis. Three months after the second surgery, she developed severe arthralgia, and high spiking fever and dyspnea appeared 6 months later. IE was suspected and large dose of antibiotics was administered. But her symptoms did not improved, she was transfered to our hospital on March in 1986.The patient had systolic heart murmur and swelling of several joints. Although erythrocyte sedimentation rate, CRP and gamma-globulin were increased, repeating venous and arterial blood cultures revealed no organisms. She had also leukopenia, high titers of anti-nuclear and anti-ds DNA antibodies. She was diagnosed as SLE, however we could not denied IE completely. Combination therapy of antibiotics and prednisolone was started. Her symptoms and laboratory abnormalities improved gradually after the treatment.Many clinical similarities exist between SLE and IE and there were some reports that IE shows leukopenia and autoantibodies. We must carefully differentiate both diseases especially after heart surgery.
日本臨床免疫学会の論文

A case of systemic lupus erythematosus mimicking the features of infective endocarditis.

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