mrjСовременная ревматологияModern Rheumatology Journal1996-70122310-158XIMA-PRESS, LLC10.14412/1996-7012-2024-2-70-74mrj-1564Research ArticleКЛИНИЧЕСКИЕ НАБЛЮДЕНИЯCLINICAL OBSERVATIONSЭндокардит Либмана–Сакса: регресс после иммуносупрессивной терапии у пациентки с системной красной волчанкойLibman–Sachs endocarditis: regression after immunosuppressive therapy in a patient with systemic lupus erythematosushttps://orcid.org/0009-0004-0430-2177ПугачВ. А.PugachV. A.

Валерия Александровна Пугач

119021, Москва, ул. Россолимо, 11, стр. 5

Valeria Aleksandrovna Pugach

11, Rossolimo Street, Build. 5, Moscow 119021

lerapugach@mail.ruhttps://orcid.org/0000-0002-3989-2590БулановН. М.BulanovN. M.

119021, Москва, ул. Россолимо, 11, стр. 5

11, Rossolimo Street, Build. 5, Moscow 119021

https://orcid.org/0000-0002-8444-544XШевцоваТ. П.ShevtsovaT. P.

119021, Москва, ул. Россолимо, 11, стр. 5

11, Rossolimo Street, Build. 5, Moscow 119021

https://orcid.org/0009-0006-6038-7384КургинянК. В.KurginyanK. V.

119021, Москва, ул. Россолимо, 11, стр. 5

11, Rossolimo Street, Build. 5, Moscow 119021

https://orcid.org/0000-0003-0148-5655НовиковП. И.NovikovP. I.

119021, Москва, ул. Россолимо, 11, стр. 5

11, Rossolimo Street, Build. 5, Moscow 119021

https://orcid.org/0000-0002-7232-4640МоисеевС. В.MoiseevS. V.

119021, Москва, ул. Россолимо, 11, стр. 5

11, Rossolimo Street, Build. 5, Moscow 119021

Клиника ревматологии, нефрологии и профпатологии им. Е.М. Тареева ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет)РоссияTareev Clinic of Internal Diseases, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)Russian Federation2024220420241827074Copyright © Пугач В.А., Буланов Н.М., Шевцова Т.П., Кургинян К.В., Новиков П.И., Моисеев С.В., 20242024Пугач В.А., Буланов Н.М., Шевцова Т.П., Кургинян К.В., Новиков П.И., Моисеев С.В.Pugach V.A., Bulanov N.M., Shevtsova T.P., Kurginyan K.V., Novikov P.I., Moiseev S.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://mrj.ima-press.net/mrj/article/view/1564

Одним из кардиальных проявлений системной красной волчанки (СКВ) может быть эндокардит Либмана–Сакса (небактериальный тромботический эндокардит, НБТЭ), который характеризуется наличием стерильных тромбоцитарных тромбов на ранее неизмененных клапанах сердца. Трудности диагностики НБТЭ связаны с тем, что часто он протекает бессимптомно до возникновения осложнений, таких как системная эмболизация или клапанная дисфункция. Пациентам с эндокардитом Либмана– Сакса и СКВ проводится иммуносупрессивная и антикоагулянтная терапия, а при ее неэффективности – хирургическое лечение. Представлена пациентка с СКВ и эндокардитом Либмана–Сакса. Обсуждаются клинические проявления, методы диагностики и лечения НБТЭ при СКВ. Продемонстрированы сложности дифференциальной диагностики и выбора оптимальной тактики ведения, с которыми сталкиваются практикующие врачи при этом заболевании.

Libman–Sachs endocarditis (nonbacterial thrombotic endocarditis, NBTE) may be one of the cardiac manifestations of systemic lupus erythematosus (SLE). It is characterized by the presence of sterile platelet thrombi on previously normal heart valves. The diagnosis of NBTE is difficult as it is often asymptomatic until complications such as systemic emboli or valvular dysfunction occur. Patients with Libman–Sachs endocarditis and SLE are treated with immunosuppressive and anticoagulant therapy and, if it is ineffective, surgical treatment.

A clinical case of SLE and Libman–Sachs endocarditis is presented. The clinical manifestations, diagnostic methods and treatment of NBTE in SLE are discussed. The difficulties in differential diagnosis and selection of optimal treatment tactics faced by physicians are highlighted.

системная красная волчанкаэндокардит неинфекционныйциклофосфамидклинический случайsystemic lupus erythematosusnoninfective endocarditiscyclophosphamideclinical caseReferencesIbrahim AM, Siddique MS. Libman–Sacks Endocarditis. In: StatPearls. Treasure Island: StatPearls Publishing; 2024 https://www.ncbi.nlm.nih.gov/books/NBK532864/Ibrahim AM, Siddique MS. Libman–Sacks Endocarditis. In: StatPearls. Treasure Island: StatPearls Publishing; 2024 https://www.ncbi.nlm.nih.gov/books/NBK532864/Libman E. A hitherto undescribed form of valvular and mural endocarditis. Arch Intern Med. 1924 Jun 1;33(6):701. doi:10.1001/archinte.1924.0011030Libman E. A hitherto undescribed form of valvular and mural endocarditis. Arch Intern Med. 1924 Jun 1;33(6):701. doi:10.1001/archinte.1924.0011030Zmaili M, AlzubiZmaili M, AlzubiYoo BW, Lee SW, Song JJ, et al. Clinicalcharacteristics and long-term outcomes of Libman–Sacks endocarditis in patients with systemic lupus erythematosus. Lupus. 2020 Aug;29(9):1115-20. doi: 10.1177/096120332 0930097. Epub 2020 Jun 14.Yoo BW, Lee SW, Song JJ, et al. Clinicalcharacteristics and long-term outcomes of Libman–Sacks endocarditis in patients with systemic lupus erythematosus. Lupus. 2020 Aug;29(9):1115-20. doi: 10.1177/096120332 0930097. Epub 2020 Jun 14.Zmaili MA, Alzubi JM, Kocyigit D, et al. A Contemporary 20-Year Cleveland Clinic Experience of Nonbacterial Thrombotic Endocarditis: Etiology, Echocardiographic Imaging, Management, and Outcomes. Am J Med. 2021 Mar;134(3):361-9. doi: 10.1016/j.amjmed.2020.06.047. Epub 2020 Aug 19.Zmaili MA, Alzubi JM, Kocyigit D, et al. A Contemporary 20-Year Cleveland Clinic Experience of Nonbacterial Thrombotic Endocarditis: Etiology, Echocardiographic Imaging, Management, and Outcomes. Am J Med. 2021 Mar;134(3):361-9. doi: 10.1016/j.amjmed.2020.06.047. Epub 2020 Aug 19.Liu J, Frishman WH. Nonbacterial Throm- botic Endocarditis: Pathogenesis, Diagnosis, and Management. Cardiol Rev. 2016 SepOct;24(5):244-7. doi: 10.1097/CRD.0000000000000106.Liu J, Frishman WH. Nonbacterial Throm- botic Endocarditis: Pathogenesis, Diagnosis, and Management. Cardiol Rev. 2016 SepOct;24(5):244-7. doi: 10.1097/CRD.0000000000000106.Joshi SB, Richards MJ, Holt DQ, et al.Marantic endocarditis presenting as recurrent arterial embolisation. Int J Cardiol. 2009 Feb 6; 132(1):14-6. doi: 10.1016/j.ijcard.2007.07.106. Epub 2007 Nov 8.Joshi SB, Richards MJ, Holt DQ, et al.Marantic endocarditis presenting as recurrent arterial embolisation. Int J Cardiol. 2009 Feb 6; 132(1):14-6. doi: 10.1016/j.ijcard.2007.07.106. Epub 2007 Nov 8.Bathina JD, Daher IN, Plana JC, et al.Acute myocardial infarction associated with nonbacterial thrombotic endocarditis . Tex Heart Inst J. 2010;37(2):208-12.Bathina JD, Daher IN, Plana JC, et al.Acute myocardial infarction associated with nonbacterial thrombotic endocarditis . Tex Heart Inst J. 2010;37(2):208-12.Roldan CA, Sibbitt WL, Greene ER, et al. Libman–Sacks endocarditis and associated cerebrovascular disease: The role of medical therapy. PloS One. 2021 Feb 16;16(2):e0247052. doi: 10.1371/journal.pone.0247052.eCollection 2021.Roldan CA, Sibbitt WL, Greene ER, et al. Libman–Sacks endocarditis and associated cerebrovascular disease: The role of medical therapy. PloS One. 2021 Feb 16;16(2):e0247052. doi: 10.1371/journal.pone.0247052.eCollection 2021.Ong ML, Veerapen K, Chambers JB, et al. Cardiac abnormalities in systemic lupus erythematosus: prevalence and relationship to disease activity. Int J Cardiol. 1992 Jan;34(1): 69-74. doi: 10.1016/0167-5273(92)90084-g.Ong ML, Veerapen K, Chambers JB, et al. Cardiac abnormalities in systemic lupus erythematosus: prevalence and relationship to disease activity. Int J Cardiol. 1992 Jan;34(1): 69-74. doi: 10.1016/0167-5273(92)90084-g.Moyssakis I, Tektonidou MG, Vasilliou VA, et al. Libman–Sacks Endocarditis in Systemic Lupus Erythematosus: Prevalence, Associations, and Evolution. Am J Med. 2007 Jul; 120(7):636-42. doi: 10.1016/j.amjmed.2007.01.024.Moyssakis I, Tektonidou MG, Vasilliou VA, et al. Libman–Sacks Endocarditis in Systemic Lupus Erythematosus: Prevalence, Associations, and Evolution. Am J Med. 2007 Jul; 120(7):636-42. doi: 10.1016/j.amjmed.2007.01.024.Roldan CA, Qualls CR, Sopko KS, Sibbitt WL. Transthoracic versus transesophageal echocardiography for detection of Libman–Sacks endocarditis: a randomized controlled study. J Rheumatol. 2008 Feb; 35(2); 224-9. Epub 2007 Dec 15.Roldan CA, Qualls CR, Sopko KS, Sibbitt WL. Transthoracic versus transesophageal echocardiography for detection of Libman–Sacks endocarditis: a randomized controlled study. J Rheumatol. 2008 Feb; 35(2); 224-9. Epub 2007 Dec 15.Zuily S, Regnault V, Selton-Suty C, et al.Increased Risk for Heart Valve Disease Associated With Antiphospholipid Antibodies in Patients With Systemic Lupus Erythematosus: Meta-Analysis of Echocardiographic Studies. Circulation. 2011 Jul 12;124(2):215-24. doi: 10.1161/CIRCULATIONAHA.111.028522. Epub 2011 Jun 20.Zuily S, Regnault V, Selton-Suty C, et al.Increased Risk for Heart Valve Disease Associated With Antiphospholipid Antibodies in Patients With Systemic Lupus Erythematosus: Meta-Analysis of Echocardiographic Studies. Circulation. 2011 Jul 12;124(2):215-24. doi: 10.1161/CIRCULATIONAHA.111.028522. Epub 2011 Jun 20.Ruiz D, Oates JC, Kamen DL. Antiphospholipid Antibodies and Heart Valve Disease in Systemic Lupus Erythematosus. Am J Med Sci. 2018 Mar;355(3): 293-298. doi: 10.1016/j.amjms.2017.07.007. Epub 2017 Jul 20.Ruiz D, Oates JC, Kamen DL. Antiphospholipid Antibodies and Heart Valve Disease in Systemic Lupus Erythematosus. Am J Med Sci. 2018 Mar;355(3): 293-298. doi: 10.1016/j.amjms.2017.07.007. Epub 2017 Jul 20.Farzaneh-Far A, Roman MJ, Lockshin MD,et al. Relationship of antiphospholipid antibodies to cardiovascular manifestations of systemic lupus erythematosus. Arthritis Rheum. 2006 Dec;54(12):3918-25. doi: 10.1002/art.22265.Farzaneh-Far A, Roman MJ, Lockshin MD,et al. Relationship of antiphospholipid antibodies to cardiovascular manifestations of systemic lupus erythematosus. Arthritis Rheum. 2006 Dec;54(12):3918-25. doi: 10.1002/art.22265.Barbhaiya M, Zuily S, Naden R, et al.2023 ACR/EULAR antiphospholipid syndrome classification criteria. Ann Rheum Dis. 2023 Jun;82(10):1258-70. doi:10.1136/ard-2023-224609Barbhaiya M, Zuily S, Naden R, et al.2023 ACR/EULAR antiphospholipid syndrome classification criteria. Ann Rheum Dis. 2023 Jun;82(10):1258-70. doi:10.1136/ard-2023-224609Banerjee S, Ahmed M, Osei-Sarpong J, et al. Libman–Sacks Endocarditis Presenting as Acute Coronary Syndrome, Acute Heart Failure and Multiple Embolic Strokes. Cureus. 2023 May 10;15(5):e38849. doi: 10.7759/cureus.38849.eCollection 2023 May.Banerjee S, Ahmed M, Osei-Sarpong J, et al. Libman–Sacks Endocarditis Presenting as Acute Coronary Syndrome, Acute Heart Failure and Multiple Embolic Strokes. Cureus. 2023 May 10;15(5):e38849. doi: 10.7759/cureus.38849.eCollection 2023 May.Macdonald RA, Robbins SI. The significance of nonbacterial thrombotic endocarditis: an autopsy and clinical study of 78 cases. Ann Intern Med. 1957 Feb;46(2):255-73. doi: 10.7326/0003-4819-46-2-255.Macdonald RA, Robbins SI. The significance of nonbacterial thrombotic endocarditis: an autopsy and clinical study of 78 cases. Ann Intern Med. 1957 Feb;46(2):255-73. doi: 10.7326/0003-4819-46-2-255.Llenas-Garcia J, Guerra-Vales JM, Montes-Moreno S, et al. Nonbacterial thrombotic endocarditis: clinicopathologic study of a necropsy series. Rev Esp Cardiol. 2007 May; 60(5):493-500. doi:10.1016/S0300-8932(07)75066-2.Llenas-Garcia J, Guerra-Vales JM, Montes-Moreno S, et al. Nonbacterial thrombotic endocarditis: clinicopathologic study of a necropsy series. Rev Esp Cardiol. 2007 May; 60(5):493-500. doi:10.1016/S0300-8932(07)75066-2.Plastiras SC, Pamboucas CA, Tektonidou M, Toumanidis ST. Real-time three-dimensional echocardiography in evaluating Libman–Sacks vegetations. Eur J Echocardiogr. 2010 Mar;11(2):184-5. doi: 10.1093/ejechocard/jep172. Epub 2009 Nov 28.Plastiras SC, Pamboucas CA, Tektonidou M, Toumanidis ST. Real-time three-dimensional echocardiography in evaluating Libman–Sacks vegetations. Eur J Echocardiogr. 2010 Mar;11(2):184-5. doi: 10.1093/ejechocard/jep172. Epub 2009 Nov 28.Roldan CA, Shively BK, Crawford MH. An Echocardiographic Study of Valvular Heart Disease Associated with Systemic Lupus Erythematosus. N Engl J Med. 1996 Nov 7; 335(19):1424-30. doi: 10.1056/NEJM199611073351903.Roldan CA, Shively BK, Crawford MH. An Echocardiographic Study of Valvular Heart Disease Associated with Systemic Lupus Erythematosus. N Engl J Med. 1996 Nov 7; 335(19):1424-30. doi: 10.1056/NEJM199611073351903.Roldan CA. Diagnostic value of transesophageal echocardiography in Libman–Sacks endocarditis. Minerva Cardioangiol. 2009 Aug;57(4):467-81.Roldan CA. Diagnostic value of transesophageal echocardiography in Libman–Sacks endocarditis. Minerva Cardioangiol. 2009 Aug;57(4):467-81.Демин АА, Кобалава ЖД, Скопин ИИи др. Инфекционный эндокардит и инфекция внутрисердечных устройств. Клинические рекомендации 2021. Российский кардиологический журнал. 2022;27(10):5233.Demin AA, Kobalava ZhD, Skopin II, et al. Infectious endocarditis and infection of intracardiac devices in adults. Clinical guidelines 2021. Rossiiskii kardiologicheskii zhurnal. 2022;27(10):5233. (In Russ.)].Habib G, Lancellotti P, Antunes MJ, et al.2015 ESC Guidelines for the management of infective endocarditis. Kardiol Pol. 2016 Jan; 69(1):69. doi:10.1016/j.rec.2015.12.002.Habib G, Lancellotti P, Antunes MJ, et al.2015 ESC Guidelines for the management of infective endocarditis. Kardiol Pol. 2016 Jan; 69(1):69. doi:10.1016/j.rec.2015.12.002.Roldan CA. Valvular disease associatedwith systemic illness. Cardiol Clin. 1998 Aug; 16(3):531-50. doi: 10.1016/s0733-8651(05) 70030-8.Roldan CA. Valvular disease associatedwith systemic illness. Cardiol Clin. 1998 Aug; 16(3):531-50. doi: 10.1016/s0733-8651(05) 70030-8.Menard GE. Establishing the diagnosis ofLibman–Sacks endocarditis in systemic lupus erythematosus. J Gen Intern Med. 2008 Jun; 23(6):883-6. doi: 10.1007/s11606-008-0627-8. Epub 2008 Apr 18.Menard GE. Establishing the diagnosis ofLibman–Sacks endocarditis in systemic lupus erythematosus. J Gen Intern Med. 2008 Jun; 23(6):883-6. doi: 10.1007/s11606-008-0627-8. Epub 2008 Apr 18.Bouma W, Klinkenberg TJ, van der Horst IC, et al. Mitral valve surgery for mitral regurgitation caused by Libman– Sacks endocarditis: a report of four cases and a systematic review of the literature. J Cardiothorac Surg. 2010 Mar 23;5(1):13. doi: 10.1186/1749-8090-5-13.Bouma W, Klinkenberg TJ, van der Horst IC, et al. Mitral valve surgery for mitral regurgitation caused by Libman– Sacks endocarditis: a report of four cases and a systematic review of the literature. J Cardiothorac Surg. 2010 Mar 23;5(1):13. doi: 10.1186/1749-8090-5-13.Chalvon NB, Costedoat-Chalumeau N,Pennaforte JL, et al. Severe Libman–Sacks endocarditis complicating antiphospholipid syndrome: a retrospective analysis of 23 operated cases. Rheumatology (Oxford). 2023 Feb 1;62(2):707-15. doi: 10.1093/rheumatology/keac315.Chalvon NB, Costedoat-Chalumeau N,Pennaforte JL, et al. Severe Libman–Sacks endocarditis complicating antiphospholipid syndrome: a retrospective analysis of 23 operated cases. Rheumatology (Oxford). 2023 Feb 1;62(2):707-15. doi: 10.1093/rheumatology/keac315.Tran HY, Duong CL, Nguyen TH, Nguyen TV. Libman–Sacks endocarditis: regression after immunosuppressive and antiplatelet therapy in a patient with newly diagnosed systemic lupus erythematosus and positive antiphospholipid antibodies. BMJ Case Rep. 2023 Sep 11;16(9):e255726. doi: 10.1136/bcr-2023255726.Tran HY, Duong CL, Nguyen TH, Nguyen TV. Libman–Sacks endocarditis: regression after immunosuppressive and antiplatelet therapy in a patient with newly diagnosed systemic lupus erythematosus and positive antiphospholipid antibodies. BMJ Case Rep. 2023 Sep 11;16(9):e255726. doi: 10.1136/bcr-2023255726.Ishizu K, Isotani A, Yamaji K, Ando K.Immunosuppressive therapy to reduce mitral regurgitation in Libman–Sacks endocarditis: a case report. Eur Heart J Case Rep. 2019 Sep 1;3(3):ytz133. doi: 10.1093/ehjcr/ytz133.Ishizu K, Isotani A, Yamaji K, Ando K.Immunosuppressive therapy to reduce mitral regurgitation in Libman–Sacks endocarditis: a case report. Eur Heart J Case Rep. 2019 Sep 1;3(3):ytz133. doi: 10.1093/ehjcr/ytz133.Salem DN, Stein PD, Al-Ahmad A, et al. Antithrombotic Therapy in Valvular Heart Disease – Native and Prosthetic. Chest. 2004 Sep;126(3):457-82. doi: 10.1378/chest.126.3_suppl.457S.Salem DN, Stein PD, Al-Ahmad A, et al. Antithrombotic Therapy in Valvular Heart Disease – Native and Prosthetic. Chest. 2004 Sep;126(3):457-82. doi: 10.1378/chest.126.3_suppl.457S.

The authors declare that there are no conflicts of interest present.